Sample Long Term Care Insurance Policy, Page 15

SAMPLE LONG TERM CARE INSURANCE POLICY

Respite Care Benefit

During Your Elimination Period, We will pay benefits for Respite Care if:
• Respite Care is received while this Policy is in effect;
• a Licensed Health Care Practitioner verifies in writing that You have met the eligibility
requirements of this Policy;
• We are provided with written proof that Your uncompensated caregiver is taking a temporary
leave of absence; and
• You are eligible for the payment of benefits under this Policy.
During Your Elimination Period, We will pay the actual charges incurred for Respite Care up to the Respite Care Benefit Amount per day for up to 21-days in any calendar year. The Respite Care Benefit Amount available during the Elimination Period is shown in the Policy Schedule. This means You do not need to satisfy Your Elimination Period before receiving benefits for Respite Care. Days that You receive Respite Care will not count toward the satisfaction of Your Elimination Period. Benefits paid for Respite Care during the Elimination Period, will reduce Your Policy Limit. After Your Elimination Period has been satisfied, We will pay the actual charges incurred for Respite Care up to the Long-Term Care Benefit Amount as shown in the Policy Schedule. In addition, benefits paid for Respite Care after Your Elimination Period has been satisfied will reduce the Policy Limit.

Care Advisory Services Benefit
We will pay the Care Advisory Services Benefit if:
• You are receiving Care Advisory Services;
• the provider of Care Advisory Services submits a written record to Us, detailing their
recommendations;
• the provider of Care Advisory Services submits their written assessment and an itemized bill; and
• You are eligible for the payment of benefits under this Policy.

We will pay the actual charges for Care Advisory Services up to the Care Advisory Services Benefit Amount as shown in the Policy Schedule. You do not have to satisfy the Elimination Period. The days for which You receive only the Care Advisory Services Benefit do not count toward the Elimination Period. Benefits paid under the Care Advisory Services Benefit will not reduce the Policy Limit.

Waiver of Premium Benefit
We will waive the payment of premiums under this Policy if:
• You are receiving care or services for which benefits are payable under the Long-Term Care Benefit; and
• You have satisfied the Elimination Period.

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