transamerica occidental life insurance company csp198 slide 1 a lot of people are thinking about...

Transamerica Occidental Life Insurance CompanyCSP198 Slide 1

A lot of people are thinking about Long- Term Care Insurance.


Transamerica hopes this short presentationwill help you make an informed decisionregarding Long-Term Care Insurance.


We Will Begin By Answering These Questions

What is meant by Long-Term Care? Types of services are available?

Where can these services be provided?

What are the chances of needing care?


We Will Begin By Answering These Questions

Who pays for Long-Term Care? How much does Medicare pay?

What is Long-Term Care Insurance? What should someone look for when

purchasing Long-Term Care Insurance?


Long-Term Care

Long-Term Care (LTC) ranges from help with day-to-day activities in the home (such as bathing, dressing, preparing meals, etc.) to more sophisticated services (such as skilled nursing care).


Long-Term Care is different from typical health services

Long-Term Care involves treatment of chronic conditions

Typical health care services are focused on

acute conditions.


Long-Term Care Services are--

Care-oriented rather than cure oriented.

Multi-dimensional, not just focused on a specific problem.

Usually provided by non-professionals or by paraprofessionals.

Services that can help us maintain our independence.


Long-Term Care Includes:

Rehabilitative Care: as a result of an accident or fall.

Therapeutic Care: post stroke or surgery. Nursing Care: wound care, changing

dressings, monitoring medicines. Personal Care: bathing, meal preparation,

transportation to and from medical appointments.


National Average LTC Costs*

Home Health Aide $12 per hour, or$96 per day

$2,880 per month$35,000 per year

Adult Day Care $45 per day $1,350 per month$16,200 per year

Assisted Living $70 per day $2,100 per month$25,200

Nursing Home $105 per day $3,150 per month$38,325 per year

*“Facts and Trends, 1995”, American Health Care Association, p. 56

Note: Amounts vary and are subject to change


Long-Term Care Can Be Provided in... One’s own home An Adult Day Care setting An Assisted Living/Residential Care Facility A Nursing Facility


What are the Chances of Needing Long-Term Care?

ONE IN TENBY AGE 55

FOUR IN TENBY AGE 65

SIX IN TENBY AGE 75

Source: American Health Care Assoc. 1994


Some People Assume Medicare Will Pay for Long-Term Care

Medicare is designed to cover acute medical care, not chronic care or disabilities due to old age.

Let’s look at some of the criteria for coverage of nursing home stays under the Medicare program.


Medicare - Nursing Facility Coverage*

Only in a Skilled Nursing Facility.The Skilled Nursing Facility must be

Medicare approved.Nursing Facility stay must follow a hospital

stay of at least 3 days.Must enter the Skilled Nursing Facility

within 30 days of discharge from the hospital. And you must enter for the same reason for which you were hospitalized.

* 1997 Guide to Health Insurance for People with Medicare National Association of Insurance Commissioners and the Health Care Financing Administration


Medicare Skilled Nursing Payments: Who Really Pays?

Benefit Medicare Pays You Pay

First 20 days 100% of None of approved

of care Approved amount, but all of

Amount non-approved amountNext 80 days Only above Up to $96.00of care $96.00 a day a day

Beyond 100 Nothing All costsdays

Facility


Y. B. Broke needs care for 277 days at $100/day = $27,700

Benefit Medicare Pays YB Pays

First 20 days 20 x $100 None of Approved

of care = $2,000 Amount, but All of

Non-Approved amount Next 80 days 80 x $4.00 80 x $96.00of care = $320.00 = $7,680

Beyond 100 Nothing 177 x $100days = $17,700 Y. B. pays $25,380(or over 91%)


A key to receiving benefits under

Medicare is the need to show improvement in your condition.

Medicare paid only 10.6% of Nursing Home costs in 1994.*

Payments Under Medicare

*Health Care Financial Review Summer 1995 Vol. 16, Number 4


Who Pays for Long-Term Care?

41%

48%

8%3%

Medicaid

Out of PocketExpenses

Medicare

Other

[Source: ACLI, March 9, 1998 pg. 9]


The vast majority of all costs are paid by the individuals themselves (out-of-pocket) or by the Medicaid program.

Not everyone is eligible to receive Medicaid Benefits.

Who Pays for Long-Term Care?


The Medicaid Alternative

Medicaid program benefits are restricted to the financially indigent. To qualify, the assets you are allowed to keep are generally limited to:

Approx. levels: $ 2,000 for a single person

$75,000 for a married couple

Note: Based on available information, may vary by state, and are subject to change.


Medicaid Qualifications Medicaid takes into account what assets you have now, and

what assets you did have. The “look back” period is as follows:*

36 months 60 months if a Trust is involved

Federal legislation enacted in 1996** includes penalties for people who assist with the transfer of assets to qualify for Medicaid: 5 years in jail and a $25,000 fine for each instance.

* Based on available information, may vary by state, and are subject to change.

** The Health Insurance Portability and Accountability Act of 1996 as amended by the Balanced Budget Act of 1997.


Medicaid Exempt Assets

The house (while spouse is living) One automobile Household and personal belongings Wedding and engagement rings Life insurance Burial plot and funeral expenses up to

$2,500


Paying back Medicaid*...

Federal legislation requires that Medicaid costs be reimbursed by the recipient’s estate.

Liens can be placed on the recipient’s home keeping the children from inheriting the home.

* As required by Public Law 104-191


The Medicaid Alternative

Some facilities are not Medicaid eligible.

Some facilities have a limited number of Medicaid beds available.


What will happenwith Medicare and

Medicaid in the future?

Furthermore, does anybody know...


The Bottom Line

If you want to choose the type of care you need and where you will receive it, Long-Term Care Insurance helps preserve your freedom of choice.Planning for your Long-Term Care needs is up to YOU.


Long-Term Care Insurance is...

LONG TERMCAREINSURANCE

An insurance policy that provides coverage for Long-Term Care. Services provided by such insurance can include:

– Rehabilitative Care

– Therapeutic Care

– Nursing Care

– Personal Care

LONG-TERMCARE

INSURANCE


Insurance Policies That Generally Do NOT Cover Long-Term Care

Medicare Supplement HMOs and Senior HMOs Disability Income Accident-Only Coverage Limited Health Coverage Basic and Major Hospital/Medical or

Surgical Coverage


Purchasing Long-Term Care Insurance Helps...

Protect you and your family from the potentially devastating cost of Long-Term Care.


A company & agent you can trust Good company ratings Excellent customer service A well written policy A policy that fits your needs Financial strength of a multi-line

company

When Shopping for a Long-Term Care Insurance Company, Look for


When Shopping for a Long-Term Care Insurance Policy, Look for:

Coverage that can be customized to meet your needs

– Adequate Daily Benefit

– Benefit Period Choices

– Elimination Period Choices

– Clear definitions of ADLs Care when you need it, where you want it

– In your own home

– In a Nursing Home

– In Assisted Living types of Facilities

– Adult Day Care Facilities



2 of 6 Activities of Daily Living Bathing as an Activity of Daily Living A clear definition of Substantial Assistance Monthly, rather than daily, Home Care benefit Coverage for Pre-existing Conditions Care coordination provided at no additional

premium cost



Expenses reimbursed up to a reasonable maximum benefit

Home Modification, Caregiver Training, Medical Alert System

Inflation Protection Options Waiver of Premium Spouse and Family discounts


Invites you to examineone solution to assist with the cost of Long-Term CareTransCare TQ SM

Transamerica Occidental Life Insurance Company


Long-Term Care Insurance Terminology

ADLs - Activities of Daily Living (basic functions) that individuals perform each day.

DB - Daily Benefit is $ amount chosen by you and used to determine amount of insurance coverage for a facility or at home.

EP - Elimination Period is the number of days you must pay for services for which no benefits are paid before insurance reimbursement begins.

Policy Maximum - The maximum amount payable over the entire term of the policy.


The best word to describe TransCare TQ policies is “Flexibility.” TransCare TQ allows you to customize a Long-Term Care Insurance policy to fit your individual needs.

The first choice you need to make is what type of policy is best for you.

TransCare TQ


Three Options Available*

Integrated Policy provides benefits for nursing and assisted living facility, at home and for community-based services.

Nursing Home and Assisted Living Facility Care Only.

Home and Community Care Only.

*Policy Form Series LTC 124-197. Some options not available in all states.


The Integrated Policy Home and Community Based

– Skilled Care (Nurse/Therapist)– Adult Day Care– Hospice Care– Home Health Aid Services– Personal Care Services– Homemaker Services

Assisted Living Facility Nursing Facility


Home and Community Based Care Only Policy Covers...

Skilled Care (Nurse/Therapist) Adult Day Care Hospice Care Home Health Aide Services Personal Care Services Homemaker Services


The Nursing and Assisted Living Facility Only Policy

Nursing Homes

–Skilled Care

– Intermediate Care

–Custodial Care Assisted Living Facilities, including

Alzheimer’s Centers.


TransCare TQ is a Reimbursement Policy

TransCare TQ pays all qualifying costs of covered Long-Term Care services, up to the daily, monthly and policy maximums selected.


Are reimbursed on a “pool of money” concept: ( Benefit x Length of Time)

The total amount available for all services is equal to the Daily Benefit (DB) times the Policy Maximum selected. For example:

$100 (DB)

x 1,460 days (Pol. Max. = 4 yrs. x 365)

$146,000 = Policy Maximum

All TransCare TQ policies...


Nursing Home Benefit

– Reimbursed up to Daily Benefit Assisted Living Facility

– Reimbursed up to Daily Benefit

Facility Reimbursement


Reimbursed up to Monthly Maximum Benefit.

No Daily Maximums.

Home and Community CareReimbursement


The monthly bucket of money is calculated by multiplying your selected Daily Benefit times the number of days in a month. For example:» 100% = (30 x 100% DB)

30 X $100 DB = $3,000/mo. » 50% = (30 x 50% DB)

30 X $100 DB x 50% = $1,500/mo.

Integrated Policies: The 50% or 100% Home Care Option


Sample Benefit Comparison

Incurred cost: $150 a day x 10 days per mo = $1,500/Mo.

ABC Ins. TransCare TQ

DB $100 per day $100 per dayHome Health % option -- 50% 100%Benefit $100 per day ($1,500) ($3,000)

Insurer Pays $1,000 $1,500 $1,500

Insured Pays $500 $0 $0


Integrated Policy

The Integrated policy is designed to provide you with more flexibility in getting care where you want it and when you need it.


The TransCare TQ Integrated policy is designed to provide benefits for care at home whenever possible.

The following benefits focus on safe, independent living at home and are not subject to an Elimination Period.

Care at Home


Home Modification– Provides benefits for necessary

modifications to your home– Up to 50 times DB

Caregiver Training

– Provides benefits for necessary training of a family or friend caregiver

– Up to 2 times DB per year

Care at Home


Therapeutic Devices–Provides benefits for the

purchase, rental or repair of necessary durable medical equipment.

–Up to 50 times DB

Care at Home


Care at Home

Medic Alert Benefit– Provides benefits for the installation of

an emergency medical communication system in your home.

– Monthly - Up to $50– Lifetime - Up to 50 times DB– Includes registration fee for Alzheimer's

Association program “Safe Return”.


Facility Care

If you need care outside the home, the TransCare TQ Integrated policy provides for care in the following types of facilities:– Nursing Homes

» Skilled, Intermediate or Custodial Care

– Assisted Living Facilities– Alzheimer’s Centers– Adult Foster Homes


Bed Reservation

– Provides benefits to retain a bed in a particular facility or as if the insured needs to be temporarily confined in an acute care hospital.

– Up to 21 days per policy year.

Highlights of TransCare TQ


Highlights of TransCare TQ

Respite Care

–Provides Respite Care Benefits so that a family

member or friend providing care can take a

business trip, go on vacation, etc.

–Up to 21 days per policy year.


Integrated policies - Alternate Plan of Care*

Services that are not specifically covered by your policy, but are agreed to by you, your doctor, your care coordinator and Transamerica.

Designed to allow us to help meet special needs you may have.

*Not Available in all states


Guaranteed renewable. Designed to have level

premiums. Fully underwritten at the

time of application.

All TransCare TQ Policies


TransCare TQ offers important benefit options.

These options enable you to customize your policy to help meet your needs.

* Some options may not be available in your state.

Flexibility*


Daily Nursing Facility Benefit (DB)– $50 - $300 ($10 increments)

Policy Maximum– 365 x DB (1 Year)– 730 x DB (2 Years)– 1,095 x DB (3 Years)– 1,460 x DB (4 Years)– 1,825 x DB (5 Years)– Unlimited

Options


Elimination Period (“E.P.”)– Single E. P. for lifetime of policy

-None -90 Days

-30 Days -180 Days*-60 Days -365 Days*

*Availability varies by state

0 - day E. P. for Home Care Only policy is not available

Options


SURVIVORSHIP BENEFITProvides a paid-up policy for the survivingspouse, after 10th policy anniversary date

NONFORFEITURE BENEFIT Reduces Lifetime maximum to sum of premiums

paid, if policy lapses

OPTIONAL RIDERS


RETURN OF PREMIUM UPON DEATHReturns premiums minus claims to

the insured’s beneficiary

INFLATION PROTECTION 5% SIMPLE OR COMPOUNDED

Provides for annual increases to the DB to help guard against inflation

OPTIONAL RIDERS


Benefit Triggers Be unable to perform, without Substantial Human

Assistance, 2 of the following 6 Activities of Daily Living (ADLs):

-Bathing - Dressing

-Continence - Toileting

-Transferring including - Eating

Mobility Be Severely Cognitively Impaired Health care professional must certify that ADL deficiency

is expected to last 90 days or longer.


Substantial Human Assistance

Transamerica believes you should know when to expect benefits from your Long-Term Care Insurance Policy

TransCare TQ defines “Substantial Human Assistance” as: actual hands-on assistance by another individual.


Transamerica’s Expanded Definition

Our Standby Assistance Amendment* expands the definition of “Substantial Human Assistance” to include standby or supervisory assistance by another individual.

The Transamerica policy and this rider specify clearly what types of assistance will be covered.

Note: In some states , i..e. (PA, WI, and GA ) included in the base policy.


All TransCare TQ coverage options provide Care Coordination. At the time of claim, a care coordinator personally visits the insured.

Care Coordination


The Care Coordinator will...

Work with the insured, the family and the doctor. Review the insured’s Long-Term Care

needs. Coordinate the development of a Plan of

Care for the insured with the physician. Assist the insured and family in securing

needed services.


The time of claim is often stressful and confusing for an individual and his or her family...the care coordinator can make a world of difference.

A World of Difference


People between the ages of 18 and 90 may apply for TransCare TQ. All policies and options are available at upper ages.

Who Can Apply for TransCare TQ?


How Much Will It Cost?

The cost of any Long-Term Care Insurance policy depends upon:Your ageThe benefits you selectYour health


Premium Discounts

Discounts Include: Preferred For married couples or Family members who live

together.


10% Preferred Discount Available...

No tobacco use in the last 5 years, and

Spend at least 10 hrs. a week outside residence.


As long as both applicants apply and are insurable, each applicant is eligible to receive a 10% discount off of his or her LTCI premiums.

10% Discount for Insurable Married Couples


Family Members Discount

Above age 505% discount for family

members who reside at the same residence.


Completion of application and medical questionnaire

Phone interview for ages 18 -74 In-person interview for age 75 - 90 Blood profile for ages 18 - 44 Medical records from your doctor Generally does not require a medical exam * Requirements vary by state

Applying for TransCare TQ*


Examples of Unacceptable Conditions at Time of Application

Alzheimer's Disease Senile Dementia Parkinson's Disease Multiple Strokes Multiple Sclerosis Dependency on walker or multi-pole

cane.


Limitations and Exclusions

This policy does NOT contain a limitation or exclusion for Pre-existing Conditions.



To prevent total benefits from exceeding actual charges, your policy benefits will be reduced if also covered by:

State or federal worker’s compensation plan Any other health plan Medicare Any other government program



Benefits will not be paid for care resulting from:

An intentionally self-inflicted injury, suicide, or attempted suicide

Treatment of alcohol, drug, or other chemical dependence

Insured’s involvement in commission of felony or other illegal activity



Benefits will not be provided for care that is: Received outside U.S., its territories, or

Canada; or Provided in a government or other facility,

unless an actual charge is made to you or your estate; or

Normally provided at no charge to you if you did not have this insurance.



Benefits will not be provided for care that is:

not included in your Service Plan; or included in your End of Coverage Plan. provided by a member of your immedate

family.


Transamerica Offers...

Local representation and service Company stability and integrity A product you can customize to suit

your Long-Term Care Insurance needs.


Transamerica Occidental Life Insurance Company Ratings

BASIS AGENCY RATING DESCRIPTION

Statutoryfinancialcondition

A.M. Best A+ Superior

Claims -paying ability

Duff & PhelpsMoody’sS & P’s

AA+Aa3AAA

Very HighExcellentExtremely Strong

transamerica occidental life insurance company csp198 slide 1 a lot of people are thinking about...

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