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Throughout this Glossary the term “we” is used and means the insurers of the Federal Program; either John Hancock Life Insurance Company or Metropolitan Life Insurance Company.

abbreviated underwriting - in this type of underwriting, the long term care insurance application has several health-related questions designed to determine who may be immediately eligible for benefits, or eligible for benefits within a short period of time. In the Federal Program, the following groups are subject to abbreviated underwriting:

activities of daily living (ADLs) - the basic activities of caring for oneself: eating, dressing, bathing, using the bathroom ("toileting"), moving back and forth from a bed to a chair ("transferring"), and remaining continent. Insurance companies use the inability to perform a specified number of ADLs to help determine eligibility for long term care benefits. The Federal Program uses the inability to perform at least 2 of the ADLs listed above.

adult day care - a place that provides a program of activities and services to individuals in need of long term care. It is a helpful option for individuals living at home whose family caregivers work during the day and who require someone to be with them throughout the day. Comprehensive plans under the Federal Program cover services at adult day care centers.

acute care - care provided by a doctor or other health care professional designed to treat or cure an illness, wound, or condition. Long term care is not acute care.

alternate plan of care - in certain circumstances, the care coordinators in the Federal Program can authorize benefits for services that are not specifically covered under the Federal Program. For example, under a Comprehensive plan, services to make your home wheelchair-accessible may be approved.

Alzheimer’s disease - a progressive neurological disease that affects brain functions, including short-term memory loss, inability to reason, and the deterioration of language and the ability to care for oneself.

assisted living facility (ALF) - a licensed residential facility that provides room, board and 24 hour personal care to individuals with long term care needs. It is an important care option for individuals who are not able to manage at home but do not need the level of skilled care provided in a nursing home. Both Comprehensive and Facilities-Only plans under the Federal Program cover services at assisted living facilities.

automatic inflation option - a method of protecting the value of insurance over time. It's a feature or option designed to help premiums remain constant over time while the benefits increase by a fixed percentage each year that may or may not be compounded. The Federal Program's Automatic Compound Inflation Option is a protection option that increases your benefits automatically by 5% compounded annually with no increase in premium.

bed reservations - if you are in a nursing home, assisted living facility, or hospice facility, and you leave that facility, the Federal Program will pay for actual charges you incur to hold a space to enable you to return to that facility. We will not pay for more than the benefit that we would pay if you had been in the facility on those days. Benefits for bed reservations are limited to 30 days per calendar year.

benefit - payment an insurance company makes for a service covered under the plan. To find out more about the Federal Program benefits click here.

benefit booklet - this is the document you will receive from Long Term Care Partners if you apply for coverage and they approve your application.  This Booklet, together with your Schedule of Benefits, describes your coverage under the Federal Program.

benefit period - the length of time your insurance will last if you receive care every day at a cost equal to or more than your daily benefit amount. If your care costs less, your insurance will last longer than the benefit period. The benefit period is used together with your daily benefit amount to calculate your maximum lifetime benefit. The Federal Program provides a choice of three benefit periods - 3 years, 5 years and unlimited.

benefit trigger - a term used by insurance companies for the requirements you must meet in order to become eligible for benefits. Benefits would actually be payable after you meet the benefit trigger and satisfy the required waiting period. There are two possible benefit triggers in the Federal Program: (1) the inability to perform at least 2 out of 6 activities of daily living for an expected period of at least 90 days or (2) requiring substantial supervision due to a severe cognitive impairment.

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care coordination services - services such as information, advice, and arranging of long term care by a professional care coordinator. In the Federal Program, care coordination services are provided by registered nurses, and are available to enrollees and their qualified relatives.

caregiver - a caregiver is the person who helps you accomplish the basic everyday activities you can no longer manage without assistance, due to illness, injury, or cognitive impairment.

caregiver training - training provided to an informal caregiver or a caregiver whose services are not covered under the Federal Program.  Caregiver training is included in Comprehensive plans and Facilities-only plans under the Federal Program.

chronic care - care provided to help maintain daily function. There is no expectation that the care recipient will improve or recover. Long term care is chronic care.

cognitive impairment - a deterioration or loss in intellectual capacity that results in impairment in some or all of the following: short and long-term memory, orientation to people, place, and time, deductive or abstract reasoning (including judgement), and ability to perform activities of daily living.

community-based services - services, such as meals on wheels and adult day care, designed to help people remain independent and in their own homes.

comprehensive option - an option under the Federal Program that covers services provided in a nursing home or assisted living facility, care at home or in an adult day care center, hospice care (in a facility or at home), and respite services (in a facility or at home), bed reservations and caregiver training.

continence - an activity of daily living - the ability of the body to control urination or bowel movements or both.

contingent nonforfeiture - a feature of the Federal Program that provides protection if you are no longer able to pay premiums due to premiums being increased to a certain level as specified by the National Association of Insurance Commissioners (NAIC).

covered services - the qualified long term care services that are covered under the option you selected (Facilities-Only Option or Comprehensive Option) under the Federal Program.

custodial care - services aimed at maintaining your health and/or preventing deterioration in your functional status, provided on an extended basis. Long term care includes custodial care.

daily benefit amount - this is the maximum amount your insurance will pay in any single day. The Federal Program offers daily benefit amounts from $50 to $300 in $25 increments.

eligible group - individuals who are eligible to apply for long term care insurance coverage under the Federal Program - also called the Federal Family. It includes Federal and U.S. Postal Service employees and annuitants, members and retired members of the uniformed services and qualified relatives. Click on the following link to find out more about eligibility.

elimination period (deductible) - see waiting period.

exclusions - - specific conditions or circumstances for which your insurance will not provide benefits. There are fewer exclusions under the Federal Program than under most other long term care insurance programs.

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facilities-only option - an option under the Federal Program that covers services provided in a nursing home or assisted living facility, hospice care in a facility, and respite services in a facility, bed reservations and caregiver training.

family member - for determining whether benefits are payable for formal or informal care under the Federal Program, this term means your spouse, child (natural, step or adopted), parent, sibling, in-laws, or grandchild.  

Federal Program - refers to the Federal Long Term Care Insurance Program.

formal care - care which is provided by a home health aide or homemaker arranged or supervised by a home care agency, or provided by a nurse or therapist.

free look period - a protection included in the Federal Program, which allows you to cancel coverage within 30 days after you receive your benefit booklet and receive a complete refund of any premium you paid.

full underwriting - the type of underwriting that you would undergo if you applied for an individual policy in the private market. Full underwriting means that applicants will have to answer numerous health-related questions. It may also include a review of medical records and/or an interview with a nurse. Applicants for the Federal Program undergo full underwriting, with the exception of the following groups:

• New and newly eligible employees and their spouses within 60 days of their hire / eligibility date
• New spouses of eligible employees within 60 days of their hire / eligibility date
• Federal and U.S. Postal Service employees first returning from nonpay status after November 2, 2002, who also were in non-pay status at least 3 months between July 1 and December 31, 2002

future purchase option - an inflation protection feature that allows you to periodically purchase additional coverage without proof of good health. The Federal Program offers a future purchase option that increases your benefits every other year with an increase in premiums.

grace period - the Federal Program includes a 30 day grace period. This means that payment of your premium must be received by the 30th day after the date it is due. If your premium is not received by the end of the grace period, a written notice of termination of coverage will be sent to you by first class mail.  You will have 35 days from the date of the termination letter to pay your premium, otherwise your coverage will end.

guaranteed renewable - a feature of tax-qualified long term care insurance plans, including the Federal Program, whereby an insurance company cannot cancel or fail to renew coverage because of a change in a person's health or age. As long as premiums are paid and benefits have not been exhausted, coverage will continue. When a plan is guaranteed renewable, such as the Federal Program, premiums may be changed on a group basis only.

hands-on assistance - when you require physical help by another person without whom you would not be able to perform the activities of daily living. Some insurance companies measure the inability to perform activities of daily living based on the need for hands-on assistance only. The Federal Program measures such need based on either the need for hands-on assistance or standby assistance.

Health Insurance Portability and Accountability Act (HIPAA) - Federal health insurance legislation passed in 1996 that specifies conditions under which certain long term care insurance policies qualify for tax advantages.

home care - services provided at home which may include nursing care; occupational, physical, respiratory or speech therapy; personal care; and homemaker services. Comprehensive plans under the Federal Program cover home care services.

home health aides - individuals who provide care to older adults or people with disabilities at home. Training or certification may vary for home health aides, but typical services they provide include assistance with activities of daily living, managing medications, and some household tasks. Comprehensive plans under the Federal Program cover services from home health aides.

homemaker services - household chores performed for someone unable to do them on their own. Comprehensive plans under the Federal Program cover homemaker services.

hospice care - services provided by a hospice for the care or management of a terminal illness.  Hospice care in a facility is covered under both the Comprehensive and the Facilities-Only options.  Hospice care at home is only covered under the Comprehensive option.

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inflation protection - a feature or option of long term care insurance coverage that increases the value of benefits over time to keep pace with increasing costs of care. The Federal Program offers a choice of two inflation protection options - an automatic compound inflation option and a future purchase option.

informal care - care provided by an unlicensed caregiver whose services are not arranged and supervised by a home care agency. Comprehensive plans under the Federal Program include coverage for informal care.

lapse - termination of insurance coverage when premium is not paid.

Licensed health care practitioner - a physician, any registered professional nurse, or a licensed social worker.

lifetime benefits - see unlimited benefit period

long term care (LTC) - personal care and other related services provided on an extended basis to people who need help with activities of daily living or who need supervision due to a severe cognitive impairment. It can be provided at home, in a nursing home, assisted living facility, or an adult day care center.

long term care insurance - insurance that helps defray the costs of assistance with the activities of daily living or the costs of supervision due to a severe cognitive impairment and allows you to receive the type of care you need in the setting that's right for you.

maximum lifetime benefit - this is the maximum amount of benefits that your insurance coverage could pay. The maximum lifetime benefit can also be referred to as a "pool of money". Your maximum lifetime benefit is calculated by multiplying your daily benefit amount times the number of days in the benefit period you selected.

Medicaid (Medi-Cal in California) - the joint Federal-state program that pays for health care services for individuals who meet their state's poverty guidelines.

Medicare - a Federal health care program for most adults age 65 and older and certain disabled individuals. It pays for long term care under limited circumstances and for limited periods of time.

Medicare Supplement Insurance (Medigap) - private insurance to help pay hospital and medical costs Medicare does not cover. It pays for long term care under limited circumstances and for limited periods of time.

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nonforfeiture - a feature that provides some value in the event coverage is cancelled. Contingent nonforfeiture is one type of nonforfeiture benefit and the type that is included in the Federal Program.

Nursing care - services requiring the professional skills of a nurse (R.N.), licensed practical nurse (L.P.N.) or licensed vocational nurse (L.V.N.).

nursing home - a licensed facility that provides 24-hour-a-day room and board, nursing care and personal care services. Nursing homes also provide medical care, therapy, and other health related services. Both Facilities-Only and Comprehensive plans in the Federal Program include coverage for care received in nursing homes.

OPM - the U.S. Office of Personnel Management.

original effective date - the date that coverage under the Federal Program becomes effective.

personal care - care to help you meet personal needs such as bathing, dressing and eating.

plan of care - a plan prescribed by a licensed health care practitioner that identifies ways of meeting your need for long term care services. To receive benefits under the Federal Program, you must have a written plan of care that we approve.

pool of money - see maximum lifetime benefit.

portable coverage - Once you have long term care insurance coverage, you can keep it, even if you are no longer a member of the eligible group, as long as you continue to pay the required premium and have not exhausted your maximum lifetime benefit. The Federal Program is fully portable.

premium - the money paid to an insurance company for coverage. The Federal Program offers a choice of three methods to pay your premium - automatic bank withdrawal, direct billing or payroll/annuity deduction.

respite services - services by a substitute provider, from a few hours to a few days, to give time off to the regular caregiver.  A benefit of some long term care insurance plans, including the Federal Program.

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schedule of benefits - the customized listing of your coverage under the Federal Program.  You will receive a copy of your schedule of benefits from Long Term Care Partners if you apply for coverage and they approve your application. This schedule, together with your Benefit Booklet, describes your coverage under the Federal Program.

severe cognitive impairment - the deterioration or loss of intellectual capacity that requires substantial supervision by another person.

spend down - depletion of income and assets to meet eligibility requirements for Medicaid (Medi-Cal in California).

spousal benefits - options offered by some insurance programs to spouses. The options may include allowing spouses who both qualify for the insurance to pay premiums that are less than if each person had purchased individual coverage and/or allowing spouses to use each other's benefits. The Federal Program does not include any spousal benefits.

standby assistance - when you require the presence of another person, within arms reach of you, to help you perform the activities of daily living. Some insurance companies measure the inability to perform activities of daily living based on the need for standby assistance, rather than or in addition to hands-on assistance. The Federal Program measures such inability based on either the need for hands-on assistance or standby assistance.

substantial assistance - hands-on or standby help required to perform activities of daily living.

substantial supervision - continual monitoring of a cognitively impaired person.

tax-qualified - conforming to Federal standards that enable the enrollee in a long term care insurance plan to receive Federal tax advantages. The Federal Program is, by law, designed to be a tax-qualified plan.

terminal illness or terminally ill - an illness or injury determined by a physician or other licensed healthcare professional to be likely to result in your death within 6 months.

toileting - an activity of daily living -- getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene related tasks.

transferring - an activity of daily living -- the ability to move in or out of a bed, chair or wheelchair.

underwriting - the process of reviewing an individual's health status to determine eligibility for coverage under a long term care insurance plan. The Federal Program uses two levels of underwriting - abbreviated underwriting and full underwriting.

unlimited benefit period - an option under some insurance plans, including the Federal Program, that pays benefits for as long as you need care, subject to your daily benefit amount or weekly benefit amount. An unlimited benefit period is sometimes called a "lifetime benefit".

waiting period - the time between becoming eligible for benefits and when your long term care insurance actually begins paying those benefits. Sometimes known as an elimination period or a deductible, it helps keep premiums affordable. The longer the waiting period, the lower the premiums. The waiting period can be measured in calendar days or days of service. A days of service waiting period is the number of days you must be eligible for benefits and receiving covered services before your benefits begin. The Federal Program includes a days of service waiting period.

waiver of premium - a provision of long term care insurance plans, including the Federal Program, that allows you to stop paying premiums while you are receiving benefits.

weekly benefit amount - a way of calculating benefits payable that is more flexible than a daily benefit amount. A weekly benefit amount under the Federal Program is calculated by multiplying the daily benefit amount you choose times 7. The weekly benefit amount is available with Comprehensive plans only.

Edition 02/24/03