What is Long-term Care Insurance?
Long-term care insurance is meant to cover financial support and/or assistance services for a person who cannot carry out Activities of Daily Living (ADL) and needs continual care. ADLs are six basic daily activities:
- standing up and lying down
- dressing and undressing
- eating and drinking
The inability to perform several of these activities usually constitutes a long-term care insurance event.
These policies are most commonly associated with fulfilling the needs of the elderly, but it is important to remember that they can be just as applicable to a younger person that encounters disabling conditions.
Through the Kupat Cholim
Long-term care insurance offered through the Kupat Cholim is a group insurance plan provided by the health fund in association with a private insurance company.
The policy is not like the other supplemental insurance plans offered by the Kupah in the following ways:
- There is no obligation to accept every applicant to this plan.
- The group insurance is for a limited period, and the insurance company is entitled not to renew it at the end of the period.
- This insurance has no connection to the Health Basket and should be regarded the same as any group health insurance policy.
Since Long Term Care Insurance is a private insurance policy, you can compare the terms of the proposed policy from the Kupat Cholim to any other policy offered by a private insurance company. A registered insurance agent can help you determine which policy is suitable and purchase it directly from the insurance company.
One who considers buying long-term care insurance should look into the following details:
Claims and Benefits
- How is the insurance event deﬁned?
- How many ADLs does it take to define the insurance event? (In most cases, the qualifying situation is the inability to perform three or four ADLs)
- Are mental frailty and Alzheimer’s included in the deﬁnition of the insurance event?
- How long can benefits be paid? (Possible periods are three years, five years, and unlimited. The duration has an effect on the level of premium.)
- What is the level of the monthly beneﬁt?
- Can the monthly beneﬁt be enlarged?
- Does the level of insurance beneﬁts depend on the insured’s age?
- Are the insurance benefits given in the form of indemnification (against actual expenses) or of compensation?
- Does the policy cover nursing care in the insured’s home?
- Are receipts required in the case of at-home care?
- Does the policy have a nonforfeiture beneﬁt, i.e., an entitlement to partial beneﬁts even if the insurance is terminated?
- Is the insurer allowed to change the premium for insureds at large (in contrast to a declared change in premium that is adjusted to the age of each insured), and under what conditions?
- Is it possible to buy a policy in which the premium does not change as the insured ages?
- What rights does the insured have in the event of an increase in premiums? (According to some policies, if the premium scale is raised the insured may pay the old price for reduced beneﬁts and/or become eligible for a nonforfeiture beneﬁt.)
- Is the insured excused from paying premiums while receiving monthly beneﬁts?
- Are the premiums for at-home care different from those upon admission to a nursing institution?