If you have coverage under the FLTCIP long-term care insurance program, or are considering purchasing it, you need to understand the conditions under which it will pay benefits. That begins with understanding that FLTCIP does not pay for general poor health but instead if you are unable to care for yourself in certain defined ways.
1. A licensed health care health practitioner certifies that:
• you are unable to perform two of six activities of daily living and your condition is expected to last at least 90 days; or
• you need substantial supervision due to a severe cognitive impairment.
2. Long Term Care Partners agrees with the certification.
3. A licensed health care professional develops a plan of care for you and LTC Partners approves that plan of care.
Activities of daily living are common activities that people perform every day, specifically:
• bathing: washing your hair, washing yourself by sponge bath, or in either a tub or shower, including the task of getting into or out of the tub or shower;
• dressing: putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs;
• transferring: moving into or out of a bed, chair or wheelchair;
• toileting: getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene;
• continence: maintaining control of bowel and bladder function, or, when unable to maintain control of bowel or bladder function, performing associated personal hygiene (including caring for catheter or colostomy bag); and/or
• eating: feeding yourself by getting food into the body from a receptacle (such as a plate, cup or table) or by a feeding tube or intravenously.
A severe cognitive impairment is an impairment or loss in:
• short or long term memory;
• orientation as to person, place and time; or
• deductive or abstract reasoning.
Such impairment or loss places you in jeopardy of harming yourself or others and therefore in need of substantial supervision by another person.
Unless you elect lifetime benefits, benefits end when the maximum benefit amount (pool of money) is exhausted. Once you have used up your benefits, you will not be able to renew or restart a policy, even if you have recovered.