YOU ASK:

What are disqualifying conditions for federal long term insurance coverage?

WE ANSWER:

The new health care bill promoted by President Obama last March 2010 created a voluntary program called the CLASS Act, or the Community Living Assistance Services and Supports Act. This program enables all Americans to have access to affordable long term insurance. The program is available for anyone, regardless of their health condition.

The CLASS Act provides coverage regardless of whether the person has had a pre-existing condition or not. The important thing is that the person has paid into the program for 5 years. Mind you, the insurance is very affordable. After 5 years of payment, they can already be qualified to claim for benefits for long-term care. The program will pay a daily benefit for the purpose of offsetting the cost of long-term care.

However, there are some disqualifying conditions for this kind of coverage. You will be disqualified if you:

  • Are not a full-time or part-time employee or a self-employed individual. If you are a part time employee or a self-employed, you must earn a certain level of income so that you can pay enough Social Security taxes.
  • You choose to opt out of the program. During the enrolment period, you have the option to say no to participation in the program. Otherwise, you will be deemed to have enrolled and the premiums will be deducted from your payroll.
  • As for claims, you will not be paid if you cannot prove that you are indeed unable to perform a certain number of day-to-day activities. You will not be paid if you can't show just how many of the Activities of Daily Living (ADL) you will need help with. You will need to show that you are unable to perform six of the ADLs, namely, toileting, moving from one place to the other, continence, eating, bathing and dressing. Other ways you can claim would be to show that even if the person if physically able, he has a cognitive impairment that still requires assistance.

There are still some things that have to be finalized, but you can be assured that the CLASS act will have a strong impact on long term care.

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