What is an Elimination Period?

Elimination PeriodI went to a client appointment the other day and the lady had a long term care policy already. She was claim eligible and as I explained her benefits to her, she stopped me. “What,” she quavered out in her tired voice, “is an elimination period?”

I explained of course – but was also humbled. Of course she didn’t know the “jargon” from the long term care insurance industry! So, in case any one else has that same question…

The elimination period in a long term care policy is essentially the deductible. It is the time window that the policyholder must pay the full cost of care, before the carrier kicks in and starts to pay. As simple as that sounds, there are a couple of tricks of the trade:

  • Find out if your elimination period has a ‘service day’ or ‘calendar day’ policy. ‘Calendar day’ means every day of the calendar that ticks by is counted towards your elimination window. ‘Service day’ means you must have evidence that you paid for services for the day to count. So, for instance, if a person has family taking care on weekends, but needs care on weekdays: under a ‘calendar day’ policy, all 7 days count, under ‘service day’, only the days when paid-for care happened, count.
  • Always file hospital and rehab days. Not every policy counts hospital and rehab stay days towards your elimination window, but many will. So, be sure you submit the documentation from those hospital and rehab days to see if these will fulfill some of your elimination window.
  • When shopping for a long term insurance care policy – always ask if it is a ‘calendar’ or ‘service’ day policy. Ask also if there is a waiver for home health care for the elimination window. You may forget the answers by the time you use the policy years later, but knowing your long term care insurance pros and cons when you buy will help you identify which policy is a better fit for you and your family.

As always, if you have problems with your long term care insurance claim or have questions, give us a call. That is what we do around here: help people shop for long term care policies and access their benefits.

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