• Outline Of Coverage
  • Full Long Term Care  Policy 52 pages
  • National Assoc of Insurance Commissioners Shoppers Guide to LTC
  • California Guide to Long Term Care
  • Aging in place (your home) vs COVID sheltering in place
• CA #Law on Long Term Care Insurance §10123 – 10237.6

• FAQ on waiting periods
• Claim benefits  are not taxable as income and the premium can be deductible.
• What are your Costs of Long Term Care and chances of needing Long Term Care?
• Medicare may pay for 90 days in a nursing home after 3 days in a hospital. ^{Publication 10153} *

Questions to ask yourself to figure out what you might need?

• If you were unable to fully take care of yourself, that is you had along term care problem, claim or event, what are your plans  to deal with the costs, emotional issues and stress on your loved ones?
  • Where will the money to deal with a disability come from to pay for your care and/or assistance?
• How will this impact your retirement nest egg?
  • And that of your spouses along with leaving money for your children?    Building a Long Term Strategy
  • Would an extra bill for $60-$80k/year in your retirement be a problem for you?

Financial Resources Questionnaire

to get the right coverage for your situation

Long Term Care

Cut & Paste these questions into an email and send to us at [email protected]

1. Seven percent of my annual income is approximately $_______________.  (This is the maximum amount of annual income experts advise spending  on a premium.)

2. The cash value of my non-housing assets* is $____________.  (This is the amount you would otherwise have to spend for long-term care.)

3. My non-housing assets would last _____________ years if I needed care today.  (This is the approximate number of years of coverage you might consider buying.)

4. I can afford to pay $____________ a day towards the cost of my own care.  The difference between the amount I can afford and the cost of care today is $_________. (This is the approximate amount of daily benefit you will need.)

5. I can afford to pay a total of $____________ for the first days of care in a nursing home. Therefore, I will need a waiting period no longer than:

30 days $__________ 60 days $__________ 90 days $____________.

(To determine the amount you would pay, multiply the daily nursing home cost times the number of days in the waiting period.) ^{Copied from Taking Care of Tomorrow} *

“7 Seven #Activities  of daily living” ADL’s –
nursing Long Term Care which include

• (1) Eating, which shall mean reaching for, picking up, and grasping a utensil and cup; getting food on a utensil, and bringing food, utensil, and cup to mouth; manipulating food on plate; and cleaning face and hands as necessary following meals.
• (2) Bathing, which shall mean cleaning the body using a tub, shower, or sponge bath, including getting a basin of water, managing faucets, getting in and out of tub or shower, and reaching head and body parts for soaping, rinsing, and drying.
• (3) Dressing, which shall mean putting on, taking off, fastening, and unfastening garments and undergarments and special devices such as back or leg braces, corsets, elastic stockings or garments, and artificial limbs or splints.
• (4) Toileting, which shall mean getting on and off a toilet or commode and emptying a commode, managing clothing and wiping and cleaning the body after toileting, and using and emptying a bedpan and urinal.
• (5) Transferring, which shall mean moving from one sitting or lying position to another sitting or lying position; for example, from bed to or from a wheelchair or sofa, coming to a standing position, or repositioning to promote circulation and prevent skin breakdown.
• (6) Continence, which shall mean the ability to control bowel and bladder as well as use ostomy or catheter receptacles, and apply diapers and disposable barrier pads.
• (7) Ambulating, which shall mean walking or moving around inside or outside the home regardless of the use of a cane, crutches, or braces.  ^{CA Insurance Code 10232.8}  *

Learn More

• wikipedia.org ADL’s
• Katz ADL scale
• Lawton IADL scale  3- point check list & scale..
  • Video = Lawton Scale of Daily Living  ADL 40 minutes
• California Insurance Code
  • Long-Term Care Insurance  10231-10237.6
  • Definitions  10231-10231.8
  • General Provisions  10232-10233.8
  • Administration and Enforcement  10234-10234.75
  • Consumer Protection 10234.8-10234.97
  • Inflation Escalator and Benefit Increases 10237-10237.6

The California Partnership for Long-Term Care

The California Partnership for Long-Term Care (Partnership) is dedicated to educating Californians on the need to plan ahead for their future long-term care and to consider private insurance as a vehicle to fund that care. The California Partnership for Long-Term Care is an innovative program of the State of California, Department of Health Care Services in cooperation with a select number of private insurance companies. These companies have agreed to offer high quality policies that must meet stringent requirements set by the Partnership and the State of California. These special policies are commonly called “Partnership policies”. Partnership policies take the guesswork out of ensuring you purchased a quality policy. In addition to many other consumer protection features, Partnership policies offer the special benefit of Medi-Cal Asset Protection.

WHAT’S NEW!

The Partnership has launched www.RUReadyCA.org an independent, easy-to-use website that offers a host of tools, information and calculators to help each Californian plan for their individually unique long-term care needs. ​​​​​​​​​​​​

• SB 1384 Task Force
• Agent Tools and Resources
• Brochures
• Consumer Information
• Contact Us

Learn more about the California Partnership for Long-Term Care on Facebook

Miscellaneous Information

• Children can pay the premium on their parents policy.
• Double check that your Long Term Carrier remains solvent and can hold their prices & promises  ^{Cal Broker Magazine} *
• Husband & Wife Planning – 2 page brochure
• Benefits are generally income tax free, see the Taking Care of Tomorrow brochure for more details.
• Premium Tax deduction if medical expenses exceed 10% or 7.5%  if over 65 ^{Mutual of Omaha} 
• If your employer pays, it’s no income to you and the employer gets a deduction.
• Medi-cal (Medicaid)  Welfare, might pay, however if you have $$$ or Property, they might put a lien on your home.
• The average cost for a private room in a nursing home in Los Angeles is $175/day.  Average hourly home heath care is  $15.
• Genworth Calculator
• Please email us [email protected] for more details.

FAQ’s
More and ask your own question 

Can I be denied because of genetic testing?

No.

The Genetic Information Nondiscrimination Act of 2008 (Pub.L. 110–233, 122 Stat. 881, prohibits the use of genetic information in health insurance and employment. The Act prohibits group health plans and health insurers from denying coverage to a healthy individual or charging that person higher premiums based solely on a genetic predisposition to developing a disease in the future. The legislation also bars employers from using individuals’ genetic information when making hiring, firing, job placement, or promotion decisions.^[1] The Act contains amendments to the Employee Retirement Income Security Act of 1974^[3] and the Internal Revenue Code of 1986.^[4]

CA Law – genomics law report.com * SB 559 – 2011 Padilla

This is our cut & paste to 12 point type and adding line spacing to the official Terms & Conditions.  NOTHING here changes anything in the official document!!!

#Terms and Conditions

The following Terms and Conditions (the “Terms and Conditions”) are hereby incorporated as an integral part of the True Freedom Enrollment and Service Contract (collectively, the “Agreement”), between American Senior Services, Inc. a Florida Corporation (“ASSI”), and the member named in and who signed the Agreement (“you”).

THIS AGREEMENT IS NOT INSURANCE, BUT RATHER CONSTITUTES A SERVICE CONTRACT. THIS IS NOT A REPLACEMENT OF ANY INSURANCE POLICY. IT IS NOT INTENDED TO BE UTILIZED AT THE TIME OF ENROLLMENT. (REVIEW SUITABILITY TO VALIDATE YOUR PURCHASE BELOW.)

A member must be able to live independently at the time of enrollment and cannot currently be in need of or receiving any assistance (including from family members) with activities such as bathing, dressing and transferring at the time of enrollment. If the intent upon enrollment is to go on service for a current condition following the initial 90-day Waiting Period, that would not be a suitable membership.

ASSI’s membership program arranges for non-medical services to be provided in the comfort of your own home, either:

ANYTIME Home Care Services can be utilized any day/ evening/ night, including weekends and overnight service (or 24 hours/ 7 days a week live-in service), up to the total number of hours specified under the plan that you purchase.

At the time that you designate a friend or neighbor for the ANYTIME Home Care Service, you will sign a release of ASSI from any liability for injuries or damages caused by your friend or neighbor.

The selected friend or neighbor must also be approved by American Senior Services, Inc. Pre-authorized requests of 8 hours or more will be considered as 24-hour live-in services for that day. Payment will not exceed $150 for a live-in friend or neighbor in any given 24-hour period.

AGENCY Home Care Service Up to five (5) hours a day, Monday through Friday between 9:00 a.m. and 5:00 p.m. by a network agency excluding National Holidays. Payments to network agency cannot exceed $150.00 a day. ASSI may change AGENCY service providers at any time.

In order to receive the AGENCY Home Care Service hours or the ANYTIME Home Care Service hours, your membership must be in effect for ninety (90) days (the “Waiting Period”), during which you cannot use any of the hours. Once the Waiting Period has elapsed, AGENCY Home Care Service hours and ANYTIME Home Care Service hours can be mixed and matched, up to the total number of hours specified under the plan that you purchase: provided however, that both AGENCY Home Care Service hours and ANYTIME Home Care Service hours cannot be utilized in any single 24 hour period.

Notwithstanding the preceding paragraph, at any time after your membership has been active for ten (10) days, if a temporary situation arises during the remainder of the Waiting Period, then you may request EMERGENCY CARE BENEFITS during the Waiting Period, which may be AGENCY Home Care Services or ANYTIME Home Care Services, with the maximum service hours available being ten percent (10%) of the initial total number of hours specified under your plan.

The Lifetime Membership Hours of each plan are equally divided into ten (10) separate bundles.

Once the service hours in the initial bundle have been exhausted, following a 90-day Rejuvenation Period (of non-use), the 2nd bundle of plan hours of a membership can be accessed.

A total of nine (9) Rejuvenation Period occur separating each bundle of hours that add up to the total Lifetime Membership Hours of a contract. All plans cover a period of twelve (12) months (each a “Term”). Unused hours from a preceding term will roll over and must be utilized before service hours in a new bundle can be accessed following a 90-day Rejuvenation Period. The Home Care Hours of any plan can rejuvenate for up to the “Maximum Lifetime Membership Hours” which is a total of 10 times the initial bundle of hours of your chosen plan. Multiple bundles of hours can be utilized within a twelve (12) month term within the parameters of the contract. Contracts must be kept current through all periods of membership and continued access to any unused service hours in a chosen plan.

TO ACTIVATE SERVICES

To receive services, call the ASSI toll free customer service number: 1-888-245-9001

Please allow between 24 and 72 hours after your call for ASSI to coordinate services. Requests should be prudent and necessary. All service requests must be pre-authorized by ASSI. All unauthorized claims will be denied, and member will be responsible for payment of those services. Contract must be paid in full if service is activated within the first 12 months. (Any membership fee discounts for non-use will discontinue when home care service is activated and will return to the original membership fee on the next payment due for the remainder of the membership.)

CANCELLATION

Non-payment of fees will result in cancellation of your membership, with cancellation occurring if a monthly bank draft fee is not paid by the due date of the contract. If a membership invoice isn’t paid within 30 days of its due date, membership will be cancelled. In addition, all memberships include a one-time 10-day cancellation period. The cancellation notice must be submitted to ASSI in writing in a signed letter (no faxes or emails), post-marked within 10-days from the effective date of your membership. Full refunds will be made during this time only.

After 10-days, you may cancel your membership at any time; however; ASSI is under no obligation to refund any portion of your membership fee.

In the event of death, your estate will be refunded on a prorated basis. Death certificate must be received within 90 days from the date of passing.

MAIL LETTER TO:

American Senior Services, Inc., 8250 Bryan Dairy Road Suite 350, Largo, FL 33777

MISCELLANEOUS

These Terms and Conditions may be amended from time to time by ASSI upon thirty (30) days prior written notice to you, sent to your home address as shown on the Enrollment Form. In the event of such unilateral amendment by ASSI, you have the right to terminate the Agreement by giving written notice of such termination to ASSI as specified above within ten (10) days after your receipt of the notice from ASSI of the amendment to these Terms and Conditions. If ASSI determines that misstatement, fraud or misappropriation of service was intended or utilized, ASSI reserves the right to terminate or revoke a membership contract.

This Agreement is made in and shall be governed by and construed under the laws of the State of Florida.

The failure of either of us to exercise any of our rights or to enforce any of the provisions of the Agreement on any occasions shall not be a waiver of such right or provision, nor affect the right of such party thereafter to enforce each and every provision of the Agreement. If any provision of the Agreement is held to be invalid, illegal, or unenforceable under any applicable statute or rule of law, then that provision shall be reformed to the maximum extent permitted to preserve the parties’ original intent as agreed by the parties; failing which, such provision shall be severed from the Agreement, with the balance of the Agreement continuing in full force and effect. This Field Issued Agreement is retained by you at the time of purchase, with a signed copy being delivered to ASSI, as well.

I have read and understand the Terms and Conditions in full.

See Enrollment form for original copy  –  Be sure to send the application back to us  [email protected]  * Secure upload

Video for BROKERS ONLY

Long Term Care Plans for #Employer Groups

• Long Term Care for Employer Groups is a business expense deduction and the benefits are received tax free. ^{bjfim.bordenhamman.com ♦ §7702 B  ♦ §104   * IRC §104 (a) (3) (a) * IRS Publication 502 Medical & Dental Expenses *  Internal Revenue Code §7702 b  Long Term Care treated as Accident & Health, just like Section 106 * Bulletin 97-31}
  • Email us [email protected]  for complementary quotes & information.
• C-Corps can benefit from complete (100%) deductibility of the tax-qualified long term care insurance premiums as a business expense. Long Term Care Insurance (LTCi) can be purchased for employees and owners.
  • Premiums are not included as part of the employees gross income
  • Coverage can be offered to spouses/domestic partners and retirees
  • Payroll taxes are not required for premiums paid
• Executive carve-outs may be established to pay all or a portion of the premium for key employees
• S-Corps Partners or More Than 2% Shareholders
  • Premiums paid for an owner are included in individual gross income.
  • A self-employed health insurance deduction can be taken for tax-qualified LTCi premiums paid. LTCi premiums are considered a medical expense and are subject to the IRS age-based limits found in the first chart on the previous page.
• Self employed individuals can deduct tax-qualified LTCi premiums as a trade or business expense similar to traditional health and accident insurance premiums. A tax deduction is allowed for the self employed individual, for his or her spouse and other tax dependents. The annual deductible maximum for each covered individual is subject to the IRS age – based limits found in this chart.   (Agent Manual)
• Technical Links & Resources
  • 26 U.S. Code § 7702 B – Treatment of qualified long-term care insurance
  • (a) (3) any plan of an employer providing coverage under a qualified long-term care insurance contract shall be treated as an accident and health plan with respect to such coverage [Section 106 tax deductibility of Medical Insurance Premiums]
  • b (1) The term “qualified long-term care insurance contract” means – click on link above to view full code & definition.
  • Revenue Procedure 2013 – 35  Maximum Contribution
  • IRS Publication 502 Medical & Dental Expenses

Tax Incentives – Maximum Deduction For Individuals – Click to ENLARGE – from Agent Manual

WHAT IS A TAX #QUALIFIED LONG-TERM CARE POLICY?

Premiums may be tax deductible

Long-term care policies that use the federal standards to cover benefits are labeled as “Federally Tax Qualified”. Some or all of the premiums for these federally tax qualified policies may be deductible as a medical expense (over 7 or 10% of income & a maximum schedule for individuals) Medical expenses also include amounts paid for qualified long-term care services and limited amounts paid for any qualified long-term care insurance contract. ^{Publication 502} on your federal and California income tax returns (depending on your age and the amount of annual premium).  ^{Health Insurance Portability and Accountability Act or HIPAA}

Policies sold as federally tax qualified long-term care insurance use a standard of eligibility for benefits that may be stricter than the standards established in California for non-qualified policies. It may be easier to qualify for benefits from non-tax qualified policies that use the standards established by California.  ^{insurance.ca.gov}  *

Benefits are not taxable as income

Since the benefits – claims payments are treated the same as accident & health insurance ^{Taking Care of Tomorrow Pages 29-31, 37-40 * Indiana.Gov  *} * ^{our webpage} *  ^Indiana.Gov 

Qualified Long-Term Care Services

Qualified long-term care services are necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, rehabilitative services, and maintenance and personal care services (defined later) that are:

1. Required by a chronically ill individual, and
2. Provided pursuant to a plan of care prescribed by a licensed health care practitioner.

Chronically ill individual.

An individual is chronically ill if, within the previous 12 months, a licensed health care practitioner has certified that the individual meets either of the following descriptions.

1. He or she is unable to perform at least two activities of daily living without substantial assistance from another individual for at least 90 days, due to a loss of functional capacity. Activities of daily living are eating, toileting, transferring, bathing, dressing, and continence.

2. He or she requires substantial supervision to be protected from threats to health and safety due to severe cognitive impairment.

Maintenance and personal care services.

Maintenance or personal care services is care which has as its primary purpose the providing of a chronically ill individual with needed assistance with his or her disabilities (including protection from threats to health and safety due to severe cognitive impairment).

Qualified Long-Term Care Insurance Contracts

A qualified long-term care insurance contract is an insurance contract that provides only coverage of qualified long-term care services.

The contract must:

1. Be guaranteed renewable,

2. Not provide for a cash surrender value or other money that can be paid, assigned, pledged, or borrowed,
3. Provide that refunds, other than refunds on the death of the insured or complete surrender or cancellation of the contract, and dividends under the contract must be used only to reduce future premiums or increase future benefits, and
4. Generally not pay or reimburse expenses incurred for services or items that would be reimbursed under Medicare, except where Medicare is a secondary payer, or the contract makes per diem or other periodic payments without regard to expenses.

The amount of qualified long-term care premiums you can include is limited. You can include the following as medical expenses on Schedule A (Form 1040).

1. Qualified long-term care premiums up to the following amounts.

a. Age 40 or under – $410.
b. Age 41 to 50 – $770.
c. Age 51 to 60 – $1,530.
d. Age 61 to 70 – $4,090.
e. Age 71 or over – $5,110.

2. Unreimbursed expenses for qualified long-term care services.

Note. The limit on premiums is for each person.

Also, if you are an eligible retired public safety officer, you can’t include premiums for long-term care insurance if you elected to pay these premiums with tax-free distributions from a qualified retirement plan made directly to the insurance provider and these distributions would otherwise have been included in your income.

Resources & Links

• Taking Care of Tomorrow Pages 29-31, 37-40
• Wikipedia
• IRS Publication 502 Medical & Dental Expenses