Long Term Care Insurance Policy, Page 7

SAMPLE LONG TERM CARE INSURANCE POLICY

Examples of such facilities may include Alzheimer facilities or Assisted Living Facilities that are either free standing facilities or part of a life-care community. They may also be met by some personal care and adult congregate care facilities.

An Assisted Living Facility does not mean:

• a hospital or clinic;

• 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.

Care Advisory Services means assessment and care planning by a Home Health Agency, a Care Management Organization or an Independent Care Manager. Care Advisory Services do not determine eligibility for benefits under this Policy. Care Advisory Services include:

• assessing Your need for long-term care services;

• developing a recommendation for long-term care services that is consistent with Your care needs based upon their assessment;

• coordinating delivery of long-term care and services; and

• monitoring the long-term care and services delivered.

Care Management Organization means an organization which:

• is licensed, if required, and operated to provide Care Advisory Services according to the laws, if any, of the jurisdiction in which it is located;

• has a full-time administrator;

• maintains records of services provided to each client; and

• has a staff including at least one full-time registered nurse, one full-time licensed social
worker, one full-time individual who holds the designation of a ‘Care Manager’ from the
National Association of Professional Care Managers, or a full-time person with a Masters in
Gerontology from an accredited school of Gerontology.

Cognitive Impairment means a deficiency in a person's short-term or long-term memory; orientation as to person, place, or time; deductive or abstract reasoning; or judgment as it relates to safety awareness. Your Cognitive Impairment must be established and reliably measured by clinical evidence and standardized tests. The need for Substantial Supervision due to the presence of Cognitive Impairment must be established by such clinical evidence and standardized tests.

Custodial Care means non-skilled long-term care included in Your Plan of Care and approved by a Licensed Health Care Practitioner: which is necessary due to Your Cognitive Impairment; or to assist You in the Activities of Daily Living.

SAMPLE LONG TERM CARE INSURANCE POLICY

Date of Service means a day that You are eligible for benefits under this Policy (including Dates of Service during the Elimination Period) on which You:

• are a resident in a Nursing Home or an Assisted Living Facility;

• receive Home Health Care or Hospice Care; or

• receive services covered under this Policy that are Medicare eligible (for which benefits are not payable under this Policy).

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