Long Term Care Insurance Policy Schedule of Benefits

UPDATED: Jul 14, 2023Fact Checked

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UPDATED: Jul 14, 2023

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UPDATED: Jul 14, 2023Fact Checked
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.
COVERED SERVICES BENEFIT AMOUNTS

 

PRIMARY SERVICES
Nursing Home
Assisted Living Facility
Respite Care – 21 days/Policy Year

 

 

-In a Nursing Home or Facility-At Home or in an Assisted Living Facility

Home Care and Community Care

ADDITIONAL SERVICES
Needs Assessment
Informal Caregiver Training

MAX DAILY BENEFIT AMOUNT
$120.00
$120.00

$100
$100

 

$100

 

MAXIMUM BENEFIT AMOUNT
Free or $250/lifetime
$500/lifetime

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
5% Automatic compound Inflation Protection Rider
Contingent Benefits Upon Lapse Rider
Paid-Up Premiums Rider
Total Annual Premium with Discounts applied
Monthly Premium Amount*

$1,277.86

ANNUAL PREMIUM*
(includes Health Rating and Discounts)

$ 365.04
$ 429.72
$ 0.00
$ 341.76
$1,136.52
$ 94.71

* If You pay premiums more frequently than annually, an additional charge has been included.

Case Studies: Long-Term Care Insurance Policy Benefits

Case Study 1: Robert W. Brown

Robert W. Brown, the insured individual, had a long-term care insurance policy with Sample Life Insurance Company. His coverage, effective since June 11, 2007, included primary services such as nursing home care, assisted living facility care, and respite care for up to 21 days per policy year.

Additionally, the policy covered home care and community care services. The maximum daily benefit amount for nursing home or facility care and at-home or assisted living facility care was $120. The policy also provided additional services like needs assessment and informal caregiver training. With a preferred health rating, Robert enjoyed discounts, including a spousal discount.

Case Study 2: Jane and Michael Thompson

Jane and Michael Thompson, a married couple, both had long-term care insurance policies. Jane’s policy covered nursing home and assisted living facility care, respite care, and home care services. Michael’s policy offered similar coverage.

Their policies had a base coverage amount with a 5% automatic compound inflation protection rider, contingent benefits upon lapse rider, and paid-up premiums rider. The Thompsons enjoyed discounts due to their preferred health ratings. The spousal discount applied as long as both policies remained in force.

Case Study 3: Susan Reynolds

Susan Reynolds, a single individual, had a long-term care insurance policy with comprehensive coverage. Her policy included nursing home care, assisted living facility care, and home care services. Susan opted for a policy with a base coverage amount and additional riders.

The policy had a gross annual premium, including health rating and applicable discounts. She paid her premiums monthly, with an additional charge for more frequent payments.

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Jeffrey Johnson

Insurance Lawyer

Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

Insurance Lawyer

Editorial Guidelines: We are a free online resource for anyone interested in learning more about legal topics and insurance. Our goal is to be an objective, third-party resource for everything legal and insurance related. We update our site regularly, and all content is reviewed by experts.

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