Glossary Terms N-R

Question 1

Non-forfeiture

Answer 1

• A feature of some plans whereby insured can retain a portion of coverage upon lapse provided insured has paid premium for a specified minimum length of time.
• Examples of Non-forfeiture are: SBP - Shortened Benefit Period; RPU - Reduced Paid up; PBB - Premium Benefit Bank
• Feature varies based on plan specifics.

Question 2

Nursing Home

Answer 2

• Facility licensed as a nursing facility under the laws of local jurisdiction, or another organization approved by MetLife, that satisfies following requirements:
• Maintains an appropriate license for a business providing maintenance or personal care and complies with laws of jurisdiction in which business is located.
• Has 24 hour a day nursing care.
• Has 24 hour a day maintenance or personal care provided by a trained/certified and awake staff supervised by a nurse.
• Maintains a written record of services provided to each client.
• Has formal arrangements for emergency medical care.
• Does not limit services to provision of food, shelter, and other residential services, such as laundry.
• Residents are not related to owner or manager of facility.
• Is not, other than incidentally, a hospital (unless a distinct part of a hospital qualifying as an nursing facility) a residential facility, hotel, motel, place for rest, home for the aged, sheltered living accommodation, facility for the treatment of mental illness, continuing care retirement community or similar entity, or place for drug addicts or alcoholics.

Question 3

Optional Periodic Inflation Insurance

Answer 3

• Option offered to insured after a specified period to increase daily benefit by an amount equal to five percent compounded annually.
• Total lifetime benefit increases proportionately.
• MetLife typically offers option every three plan years.

Question 4

Pre-HIPAA

Answer 4

• A long-term care insurance plan written prior to enactment of the HIPAA regulations which became effective 01/01/97.
• Most, but not all, pre-HIPAA plan were grandfathered under regulations and therefore given favorable tax treatment.
• See HIPAA for more information.

Question 5

Proof of Insurability (Good Health)

Answer 5

• Generally consists of completion of a health questionnaire.
• In most circumstances, insureds must provide MetLife with evidence of insurability in order to increase coverage.
• Proof of good health is also required during initial enrollment period for all eligible classes, with the except of active employees eligible for guaranteed issue.

Question 6

Reinstatement

Answer 6

• An individual whose coverage has been canceled may be reinstated at his or her original age-at-entry within one year of lapse.
• Individual must re-apply by completing a health questionnaire and paying all past due premium.
• Individuals who can prove loss of functional capacity or cognitive impairment at time of lapse may be reinstated within five months without providing proof of insurability.
• Individual must still pay all past due premiums.

Question 7

Respite Care

Answer 7

• Provides temporary “time off” to primary caregiver (spouse, daughter, son, or friend).
• Can be received for care at home or for a temporary stay in a nursing home,
• Typically covers for up to 21 days per calendar year.
• Informal care may be included as part of respite care benefit.

Question 8

ROC (Return of Contribution)

Answer 8

• A feature that returns some or all of premiums paid, minus benefits received, upon death of insured.
• Amount of premium returned, if any, varies depending on age of insured at death and on plan specifics.
• Most employer plans include feature.
• AARP and individual plans offer feature to applicant as an option.

Question 9

ROP (Return of Premium)

Answer 9

MetLife will return any premiums paid past an insured’s death to whoever is authorized to receive the refund.