Using your coverage · Section 2 of 5
Before you need it: know your policy
The most common mistake families make is opening the policy for the first time in the middle of a crisis.
Locate the policy, and who services it today
Find the full policy contract — not the annual statement — including any riders and amendments. If you cannot find it, request a copy from the carrier; you are entitled to one. Then confirm who administers the policy now: many policies sold in the 1990s and 2000s are serviced by a different company than the one on the letterhead, and the customer service number on your most recent premium statement is usually the right starting point. A carrier leaving the sales market does not cancel your policy — claims on existing policies are still paid.
Find these five things in your policy
The benefit trigger
Most policies pay when a licensed health practitioner certifies that you need substantial assistance with at least two of six activities of daily living — bathing, dressing, toileting, transferring, eating, continence — or that you need supervision due to cognitive impairment such as dementia. For tax-qualified policies, which is most policies sold after 1996, the condition must be expected to last at least 90 days. These are the same six activities from the daily activities check in Section 1.
The elimination period
This is the waiting period — commonly 30, 60, 90, or 100 days — before benefits begin. Critically, check whether your policy counts calendar days or service days.
The benefit amount
Your daily or monthly maximum. If your policy includes an inflation protection rider, the current benefit may be substantially higher than the number printed on the original policy. Check your most recent annual statement for today’s figure, and use that figure in your planning.
The benefit period or benefit pool
Some policies pay for a set period, for example three years. Most modern policies define a total pool of money that lasts as long as it lasts. If you spend less than the daily maximum, the pool stretches longer — an important fact when comparing care options in Section 4.
The covered provider definitions
This is the section families most often skip, and the one that determines everything about how you can use your benefits. Policies differ significantly in which caregivers and settings qualify. It gets its own section: Approved providers.