Long Term Care Insurance Policy, Page 10

SAMPLE LONG TERM CARE INSURANCE POLICY

Licensed Health Care Practitioner means a Physician, a registered nurse (R.N.), a licensed social worker, or any other individual who meets the requirements as may be prescribed by the Secretary of the Treasury. You may select any Licensed Health Care Practitioner of Your choosing. However, a Licensed Health Practitioner may not be a member of Your Immediate Family.

Long-Term Care Services means the following covered care or services:

• confinement in a Nursing Home or Assisted Living Facility for room, board and care services (such care services being Nursing Care, Custodial Care and Hospice Care);

• Home Health Care, Hospice Care, Respite Care; or

• attendance at an Adult Day Care Center providing Adult Day Care.

Medicaid means the reimbursement system under Title XIX of the Federal Social Security Act, as amended.

Medicare means the reimbursement system under Title XVIII of the Federal Social Security Act, as amended.

Nursing Care means skilled or intermediate care provided by one or more of the following health care professionals: registered nurse, licensed vocational nurse, licensed practical nurse, physical therapist, occupational therapist, speech therapist, respiratory therapist, medical social worker or registered dietitian.

Nursing Home means a facility which:

• is licensed and operated to provide Nursing Care for a charge (including room and board), according to the laws of the jurisdiction in which it is located; and

• has services performed by or under the continual, direct and immediate supervision of a
registered nurse, licensed practical nurse or licensed vocational nurse, on-site twenty-four (24) hours per day.

A Nursing Home may be a freestanding facility or it may be a distinct part of a facility, including a ward or a wing of a hospital or other facility.

Nursing Home does not mean:

• a hospital or clinic;

• a swing-bed in a hospital;

• a rest home (a home for the aged or a retirement home) which does not, as its primary
function, provide Custodial Care;

• Your Home; or

• a facility for the treatment of alcoholism, drug addiction, or mental illness.

Physician means any person licensed as a Medical Doctor (M.D.) or Doctor of Osteopathy (D.O.) practicing within the scope of his or her license issued by the jurisdiction in which the services are rendered.

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