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CA Department of Insurance

Glossary for Long Term Care

2005 Edition

Select the first letter of the term you are looking for to go directly to that portion of the glossary.

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Activities of Daily Living (ADL) - Everyday functions and activities individuals usually do without help. ADL functions include bathing, continence, dressing, eating, toileting, transferring, and for non-tax qualified policies, ambulating (California Insurance Code [CIC] 10232.8 [a] [2] for Non-Tax Qualified and CIC 10232.8 [d] for Federally Qualified LTC policies).

Adult Day Care - Is a medical or nonmedical care on a less than 24-hour basis, provided in a licensed facility outside the residence, for persons in need of personal services, supervision, protection, or assistance in sustaining daily needs, including eating, bathing, dressing, ambulating, transferring, toileting, and taking medications (CIC 10232.9 [b] [2]).

Alzheimer's Disease and related progressive, degenerative, and dementing illness - Significant destruction of brain tissue with resultant loss of brain function, including, but not limited to, progressive, degenerative, and dementing illnesses. Based on clinical diagnosis not dependent on pathological confirmation, but employing nationally accepted criteria (CIC 10123.16).

Benefit Triggers - Term used by insurance companies to describe when to pay benefits.


Care Management Services - Services in which a professional, typically a nurse or social worker, may arrange, monitor, or coordinate long-term care services.

Community-Based Services - Services designed to help older people stay independent and in their own homes.

Daily Benefit - The amount of insurance benefit in dollars a person chooses to buy for long-term care expenses.

Dementia - Deterioration of intellectual faculties due to a disorder of the brain.

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Elimination Period - A type of deductible; the length of time the individual must pay for covered services before the insurance company will begin to make payments. The longer the elimination period in a policy, the lower the premium.

Guaranteed Renewable Policies - A policy that cannot be cancelled and must be renewed when it expires unless benefits have been exhausted. The company cannot change the coverage or refuse to renew the coverage for other than nonpayment of premiums.

Health Insurance Portability and Accountability Act (HIPAA) - Federal health insurance legislation passed in 1996 that allows, under specified conditions, long-term care insurance policies to be qualified for certain tax benefits.

Home Health Care - Is a skilled nursing or other professional services in the residence, including, but not limited to, part-time and intermittent skilled nursing services, home health aid services, physical therapy, occupational therapy, or speech therapy and audiology services, and medical social services by a social worker (CIC 10232.9 [b] [1]).

Homemaker Services - Is assistance with activities necessary to or consistent with the insured's ability to remain in his or her residence that is provided by a skilled or unskilled person under a plan of care developed by a physician or a multidisciplinary team under medical direction (CIC 10232.9 [b] [4]).

Hospice Services - Out patient services not paid by Medicare, that are designed to provide palliative care, alleviate the physical, emotional, social and spiritual discomforts of an individual who is experiencing the last phases of life due to the existence of a terminal disease and to provide supportive care to the primary care giver and the family (CIC 10232.9).

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Impairment of Cognitive Ability - Deterioration or loss of intellectual capacity due to organic mental disease, including Alzheimer's disease or related illnesses, that requires continual supervision to protect oneself or others (CIC 10232.8[a][2]).

Inflation Protection - A policy option that provides for increases in benefit levels to help pay for expected increases in the costs of long-term care services.

Lapse - Termination of a policy when a renewal premium is not paid.

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Medicaid (Medi-Cal in California) - A joint federal/state program that pays for health care services for those with low incomes or very high medical bills relative to income and assets.

Medicare - The federal program providing hospital and medical insurance to people aged 65 or older and to certain ill or disabled persons. Benefits for nursing home and home health services are limited.

Medicare Supplement Insurance - A private insurance policy that covers many of the gaps in Medicare coverage.

National Association of Insurance Commissioners (NAIC) - Membership organization of the nation's insurance commissioners. One of its goals is to promote uniformity of state regulation and legislation related to insurance.

Non-cancelable Policies - Insurance contract that cannot be cancelled and the rates cannot be changed by the insurance company.

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Preexisting Condition - Illnesses or disability for which you were treated or advised within a time period before applying for a life, health or long-term care insurance policy.

RCFE - Residential Care Facilities for the Elderly.

Rescind - When the insurance company voids a policy back to the effective date.

Residential Care Facility - A facility licensed as a residential care facility for the elderly or a residential care facility as defined in the Health and Safety Code. Outside California, eligible providers are facilities that meet applicable licensure standards, if any, and are engaged primarily in providing support needs resulting from impairment in activities of daily living or impairment in cognitive ability and which also provide care and services on a 24-hour basis, have a trained and ready-to-respond employee on duty in the facility at all times to provide care and services, provide three meals a day and accommodate special dietary needs, have agreements to ensure that residents receive the medical care services of a physician or nurse in case of emergency, and, have appropriate methods and procedures to provide necessary assistance to residents in the management of prescribed medications (CIC 10232.92 [a]).

Respite Care - Is short-term care provided in an institution, in the home, or a community-based program, that is designed to relieve a primary care giver in the home (CIC 10232.9 [b] [6]).


Spend Down - A process of spending excess assets to meet Medicaid eligibility requirements.

Substantial Assistance - A term that means hands-on, or stand-by help, required to do ADL.

Substantial Supervision - A term that means the presence of a person directing and watching over another who has a cognitive impairment.

Tax-Qualified Long-Term Care Insurance Policy - A policy that conforms to certain standards in federal law and offers certain federal tax advantages.


Waiver of Premium - A provision in an insurance policy that relieves the insured of paying the premiums while receiving benefits.


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