Long Term Care Premium Payments, Grace Periods

UPDATED: Jul 14, 2023Fact Checked

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Jeffrey Johnson

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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...

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UPDATED: Jul 14, 2023

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UPDATED: Jul 14, 2023Fact Checked

The provisions in the sample long term care insurance policy clearly state the specific conditions under which benefits will not be paid. Most policies contain provisions similar to those outlined below.

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The premium is due and payable on the Original Coverage Effective Date of the Policy and thereafter in accordance with the Premium Schedule that is in effect for the Policy as shown on the Schedule of Benefitspage. The premium must be paid in U.S. currency.

COMMENT: The premium shown on the Schedule of Benefits page breaks down the premium for the policy and any riders separately, subtracts any discounts and then shows the total amount to be paid by the time period (the monthly, quarterly, semi-annual or annual mode) you selected.

You may change the premium payment mode with Our approval.

The amount of the premium for Your initial coverage is based on Your Original Issue Age, Health Rating and Discounts, as of the Original Coverage Effective Date as shown on the Schedule of Benefitspage.

COMMENT: The Health Rating describes the class of coverage you to which you are assigned by the insurance company based on your health history (e.g., Sub-Standard, Standard, Preferred). This affects your premium. The better your Health Rating, the lower your premium.

We reserve the right to change premium rates on a class basis. The premium will not increase because You get older or Your health changes. Your premium will change if We change Your benefit amounts as a result of Your request or as a result of an increase as provided under the terms of the Policy.

COMMENT: Most long term care policies, like this one, only allow the insurance company to change the premium rates on a policy if it changes the rates for all polices in the class. For example, if you are issued a policy in the Preferred class and the insurer increases the premium for your policy, it is required to increase the premium for all similar polices in the same class (Preferred) as yours. Typically, an insurance company might increase premium if it notices that its loss experience (more benefits being paid that premium being collected) for a particular class of a particular policy is not good.

Grace Period

The provisions in the sample long term care insurance policy clearly state the specific conditions under which benefits will not be paid. Most policies contain provisions similar to those outlined below.

_____________

You have a Grace Period of thirty-one (31) days to pay each premium due after the first premium. If the premium is not paid by the end of the Grace Period, We will send a written notice of Lapse of the Policy to You and to any person names to receive such notice a the addresses given to Us. You have thirty-five (35) days after We mail this notice to pay the premium. The policy will stay in force during this time unless We receive a written request from You to cancel the Policy. If We do not receive the premium within thirty-five (35) days of mailing the notice, the policy will then Lapse.

If a claim is payable for services incurred prior to Lapse, any unpaid premiums due will be deducted from the claim payment.

You have the right to name a person to receive notice of Lapseat the same time We send such notice to You. The person named will not be responsible for payment of the premium. You are responsible to inform Us of any change relating tot the person named. We will inform you of Your right to change the person named at least once every two (2) years.

COMMENT: Take note that the policy does not, in fact, lapse at the end of the 31-day Grace Period. The insurance company does not want to lose your business. For that reason, it gives you a third chance to pay your premium after the end of the original due date and before it lapses your policy. It also encourages you to name a second person to receive notices regarding premiums, recognizing the fact that many people who have long term care insurance premiums coming due may be approaching the forgetful stage of their lives and inadvertently stop paying their premium.

Case Studies: Long Term Care Insurance – Premium Payments and Grace Periods

Case Study 1: Missed Premium Payment John’s Situation

John, a policyholder, faces a challenging situation when he forgets to pay the premium on the original coverage effective date. As a result, he misses the payment deadline. John’s case study: Non-payment consequences and insurance company actions highlighted. Timely premiums crucial, payment failures have ramifications.

Case Study 2: Change in Premium Payment Mode  Sarah’s Request

Sarah, another policyholder, finds herself in a situation where she needs to change the premium payment mode of her long-term care insurance policy. We explore Sarah’s request and the process involved in requesting a change in the payment mode. Additionally, we delve into the approval process required by the insurance company.

Case Study 3: Premium Rate Changes Impact on Mark

Mark, a long-term care insurance policyholder, experiences unexpected premium rate changes on a class basis. We analyze the impact of these changes on Mark’s policy and examine whether the premium increases due to age or health changes. Mark’s case study allows us to understand how premium rate adjustments can affect policyholders and the factors that contribute to such modifications.

Case Study 4: Grace Period and Policy Lapse John’s Dilemma

John finds himself facing a dilemma when he fails to pay the premium within the designated grace period. We explore the concept of a grace period and its significance in providing policyholders with an opportunity to rectify missed payments. Furthermore, we discuss the potential consequences of a policy lapse due to non-payment and the options available to John to address this situation.

Case Study 5: Unpaid Premiums and Claim Payments Sarah’s Experience

Sarah encounters an issue where her unpaid premiums are deducted from her claim payment for services incurred prior to the policy lapse. We delve into the implications of this deduction on her claim amount and discuss the reasoning behind such a policy provision. Sarah’s case study: Unpaid premiums affect claim settlements, impacting policyholders’ benefits.

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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.

Get Legal Help Today

Find the right lawyer for your legal issue.

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