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Activities of Daily Living —Personal care activities that may include bathing, dressing, eating, transferring, toileting, continence, and mobility.
Acute Care — Critical care provided by a doctor or other health care professional designed to treat or cure an illness, wound, or condition. This care is usually received in a critical care facility such as a hospital or acute rehabilitation center. Long-term care is not acute care.
Adult Day Care — A program that provides activities and services to individuals in need of long-term care. Adult Day Care centers provide care for less than 24 hours per day.
Alternate Care Benefit – A special arrangement of services specifically designed to allow you to reside in a setting other than a nursing facility. It may be any combination of: services to provide you assistance, e.g., Home Health Care, Home Improvements, and Durable Medical Equipment.Assisted Living Facility — A residential facility that provides room, board, and 24-hour personal care to individuals with long-term care needs. It is a care option for individuals who are not able to manage at home, but do not need the level of skilled care provided in a nursing home. It may also be called a Custodial Care facility.
Bed Hold Benefit — If your stay in a Nursing Home or Assisted Living Facility is interrupted because you are hospitalized, we will continue to pay benefits to assure a place will be available when you return to the same facility. The duration of benefits available varies; please check your policy coverage for the specific number of days available.
Benefit Amount (Daily/Monthly) — Your Benefit Amount represents the maximum amount of money per day or per month*, as chosen by you, that your policy will provide to cover your long-term care needs.
* The maximum amount paid per day is the Daily Benefit amount. The maximum amount paid per month is the Monthly Benefit amount.
Benefit Period — The minimum period of time (years) you can expect your coverage to last.
Care Advisory Services — Refers to the assessment and care planning by a Home Health Agency, a Care Management Organization, or an independent care manager.
Care Coordinator — A licensed health care practitioner employed by or under contract with John Hancock or a care coordination organization. Services may include:
- A face to face assessment of your need for long-term care services,
- A written plan of care
- Monitoring the delivery of services as may be appropriate
Caregiver — A person who helps you accomplish the basic everyday activities you can no longer manage without assistance; due to illness, injury, or cognitive impairment.
Care Management Organization — An organization that is licensed, if required, and operated to provide Care Advisory Services according to the laws, if any, or the jurisdiction in which it is located.
Cognitive Impairment — A deterioration or loss in intellectual capacity that results in impairment in some or all of the following: short and long-term memory, orientation to people, place, and time, deductive or abstract reasoning (including judgment).
Community Based Professional Care — Home health care, homemaker services, personal care, respite care, and hospice care rendered by a qualified provider in your home or adult day care provided in a qualified adult day care center.
Coordination of Benefits — In some instances benefits that are available under your Long-Term Care policy may coordinate with other insurance or government programs such as Medicare and Medicaid. Policies do not cover services, including co-insurance or deductibles when Medicare is covering your long-term care. In some instances your policy may be able to cover services in addition to those paid for by Medicare, for example if you are receiving skilled home health care covered by Medicare you may also be eligible to receive custodial home health care that Medicare is not covering.
Covered Charges — Charges incurred that are covered by your long-term care policy. Typically covered charges include such things as Home Health Care both skilled and custodial, room and board in an Assisted Living Facility or Skilled Nursing Facility.
Custodial care — Non-skilled long-term care services aimed at maintaining your health and/or preventing deterioration in your functional status.
Daily Benefit — The maximum amount your long-term care insurance will pay in any single day.
Date of Service — A day that you are eligible for benefits under your policy, including Dates of Service during the Elimination period.Durable Medical Equipment— Item(s) you rent or purchase designed to be used in your home to assist you in performing the Activities of Daily Living.
Elimination Period (Qualification Period) — The Elimination Period on your long-term care insurance policy is like a deductible. Before your LTC policy will begin paying benefits, you must first pay for your own long-term care costs for a certain number of days. In some policies, the Elimination Period is dates of service, and in others, it is calendar days. Please refer to your policy’s definition.
HIPAA (Health Insurance Portability and Accountability Act) — Federal health insurance legislation passed in 1996 that sets standards for long-term care insurance policies to meet in order to qualify for federal income tax advantages
Home Health Aide — non-medical professional who provides custodial care in your home
Home Health Care — Medical and non-medical professional or personal care services provided in your home. Home Health Care may include occupational, physical, respiratory, or speech therapy, as well as custodial and/or nursing care.
Home Modification — Physical adaptations to a home that enable a person to stay and function in the home.
Homemaker services — The non-medical and incidental support services that are necessary for you to be able to remain in your own home: meal preparation; laundry; light housekeeping; and supervising self-administration of medicine.
Hospice care — Care intended to alleviate physical, emotional, or spiritual discomforts near the end of life.
Illness — Your sickness or disease, as determined by a doctor.
Injury — An accidental bodily injury that you sustain.
Licensed health care practitioner — A physician, a registered nurse (R.N.), a licensed certified social worker (LCSW), or any other individual who meets the requirements as may be prescribed by the Secretary of the Treasury.
Lifetime Maximum Benefit — The total pool of money payable for covered long-term care services received while insured
Long-Term Care — Personal care and other related services provided on an extended basis to people who need help with activities of daily living or who need supervision due to a severe cognitive impairment. Long-Term Care can be provided at home, in a nursing home, assisted living facility, or an adult day care center.
Long-term Care (LTC) insurance — Insurance that helps defray the costs of assistance with the activities of daily living or the costs of supervision due to a severe cognitive impairment.
MDS — the Minimum Data Set is a federally-mandated process for clinical assessment of all residents in Medicare/Medicaid-certified nursing homes. This assessment contains information in a variety of categories including, but not limited to: cognitive patterns, physical functioning, disease diagnoses, and treatments/procedures.
Medicaid — The joint Federal-State program that pays for health care services for individuals who meet their state’s poverty guidelines. In the event that Medicaid pays for your care services, you must notify John Hancock.
Medicare — A Federal health care program for most adults age 65 and older and certain disabled individuals. It pays for long-term care under limited circumstances and for limited periods of time.
Monthly benefit — The maximum amount your long-term care insurance will pay in any single month.
Non-duplication of benefits — Your policy will only pay covered charges in excess of the charges covered under Medicare (including amounts not reimbursable by Medicare such as a Medicare deductible or coinsurance amounts) (this means that your policy will not pay for your Medicare deductibles or coinsurance), other government programs (excluding Medicaid) or any state or federal workers’ compensation, employer’s liability or occupational disease law.
Nursing Care — Skilled or intermediate care provided by one or more of the following health care professionals: registered nurse (R.N.), licensed vocational nurse, licensed practical nurse, physical therapist, occupational therapist, speech therapist, respiratory therapist, medical social worker or registered dietician.
Nursing home — A licensed facility that provides 24-hour-per-day room and board, nursing care and personal care services. Nursing homes also provide medical care, therapy, and other health related services.
Onsite Assessment — is a tool that John Hancock uses to verify if an insured meets the benefit eligibility requirements defined in a policy. The assessment consists of a face-to-face interview conducted by a licensed health care practitioner. This typically takes place in the insured’s place of residence. The interview includes questions about the physical and cognitive status of the insured and may ask the insured to demonstrate functional status.
Period of Care – A Period of Care is the period of your claim and is measured from your first Date of Service and ends when there is 180 consecutive days for which you have not received covered services.
Plan of care — A plan prescribed by a licensed health care practitioner that identifies services that meet your long-term care needs
Policy limit — The total amount from which you will be paid benefits for all covered care and services. All benefits will be deducted from the policy limit. John Hancock will not pay benefits in excess of the policy limit.
Respite Care – Short-term care designed to provide temporary relief to your primary caregiver. Respite care may be provided in a Skilled Nursing Facility, Assisted Living Facility, Adult Day Care, or your home.
Restoration of Benefits – When you are no longer eligible for benefits for a period of 180 consecutive days or more, and if you have not exhausted available benefits, we will restore the full Policy Limit.
Skilled nursing care — Nursing care that is performed by skilled medical personnel. It can be either in a facility setting or at home. (Note: Medicare and Medicaid have their own definitions of “skilled nursing care” which do not necessarily match those in long term care insurance policies.)
Skilled nursing facility — Generally a state-licensed institutional setting that provides skilled care by skilled medical personnel. This care is available 24 hours a day and is ordered by a physician under a treatment plan.
Stay at Home Benefit — Additional funds available that can be used to pay for a variety of long-term care expenses while you are living in your home that are not otherwise covered under the policy.
Additional Stay at Home Services consist of:
- Home modifications
- Emergency medical response systems
- Durable medical equipment
- Caregiver training
- Provider care checks
- Home safety checks
Substantial assistance — Hands-on or standby assistance from another individual while you are performing activities of daily living.
Substantial supervision — Continual supervision, due to your cognitive impairment, by another person that is necessary to protect you from threats to your health or safety.
Tax Qualified – a type of policy that requires a Licensed Health Care Practitioner to certify, on an annual basis, that the insured is unable to perform, without substantial assistance from another individual, at least two activities of daily living due to the loss of functional capability for a period expected to last 90 days; or that the insured requires substantial supervision to protect him/herself from threats to health or safety due to the presence of a cognitive impairment.
Third-Party Billing Notification – This feature helps you to avoid unintentional lapse of your coverage by giving you the opportunity to designate a person to receive a notice of cancellation in case of nonpayment. This person is called a Third-Party Designee.
UB04 — is a billing standard used for Medicare charges. Charges outlined on the UB04 may help credit your Elimination Period. However, we are unable to accept a Medicare Explanation of Benefits in place of the UB04. You should contact your long-term care service provider to obtain a copy of any applicable UB04 forms
Waiver of premium — A provision on your policy detailing when premiums are no longer payable because of your claim status. The trigger for this benefit varies by policy. It is imperative that you continue to pay premiums until you have received confirmation from John Hancock that your policy is in a Waiver of Premium status. In the event that your claim closed for any reason, premium payments would resume.