Long Term Care Insurance Policy Schedule of Benefits
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Written by
Jeffrey Johnson
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UPDATED: Jun 19, 2018
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| COMMENT: The following is a typical Schedule of Benefits page for a long term care insurance policy. |
Sample Life Insurance Company
P.O. Box 123456
Anytown, NY 22212-7890
Toll Free Number: 1-800-987-6543
SCHEDULE OF BENEFITS
INSURED
Robert W. Brown
CURRENT COVERAGE: EFFECTIVE DATE – June 11, 2007
(REPLACES ANY PREVIOUS SCHEDULE OF BENEFITS)
| Original Coverage Effective Date Original Issue Age Policy Number Plan Number Elimination Period TOTAL LIFETIME BENEFIT (does not reflect claims paid or payable) | June 11, 2007 46 06758-493210 6758 100 days $500,000 |
| COMMENT: The Elimination Period is the total number of days after the Original Coverage Effective Date during which the Insured must be Chronically Ill and receiving Primary Services before certain Benefits become payable. No Elimination Period is required in order to receive Benefits for Respite Care, Needs Assessment or Informal Caregiver Training. The Insured only has to satisfy the Elimination Period once during the lifetime of the Policy. |
PRIMARY SERVICES
Home Care and Community Care ADDITIONAL SERVICES | MAX DAILY BENEFIT AMOUNT $100 MAXIMUM BENEFIT AMOUNT |
Health Rating: Preferred
Discounts: Spousal Discount
Spousal Discount applies as long as associated policies remain in force.
| COMMENT: The Spousal Discount applies when, and only when each spouse has an individual long term care insurance policy with Sample Life. |
PREMIUM SCHEDULE
Gross Annual Premium (includes Riders and Health Rating; does not include Discounts, if any) COVERAGE Base Coverage | $1,277.86 ANNUAL PREMIUM* $ 365.04 |
* If You pay premiums more frequently than annually, an additional charge has been included.