Glossary Terms A-C

Question 1

Activities of Daily Living (ADL)

Answer 1

A Measure of an individual’s level of independence or dependency
Activities people who live independently do every day, such as bathing, dressing, transferring, toileting, continence, and eating.

Question 2

Acute Care

Answer 2

• Also known as medical care.
• Care provided by a doctor or other health care professional to treat or cure an illness, injury, wound, or medical condition.
• Typically lasts a short time, unlike long-term care which treats chronic, long-lasting conditions.

Question 3

Adult Day Care

Answer 3

• Daytime, community-based program for functionally or cognitively impaired adults providing a variety of health, nutrition, social, and related services in a protective setting to those otherwise being cared for by family members.
• Enables individuals to remain at home and in community
• Encourage family members to care for adult individuals by providing relief from burden of constant care.
• Alternately, a facility operated, licensed and/or certified as an adult day care center under laws of jurisdiction in which it is located.

Question 4

Alzheimer’s Disease

Answer 4

• Progressive, irreversible disease involving degeneration of brain cells.
• Leads to impairment or loss of mental functions, such as orientation to person, place, or time; short and long-term memory; and ability to reason.

Question 5

Assisted Living Facility

Answer 5

• Facility maintaining all appropriate licensing required under laws of jurisdiction in which it is located to provide maintenance or personal care.
• Provides many of same services as a nursing home, with a more residential atmosphere.
• Provides 24-hour supervision by trained and awake staff and provides services such as laundry and meals.
• May be appropriate when insured is unable to take care of themselves at home, but a nursing home is more care than insured wants or needs.
• Not, other than incidentally, a hotel, motel, a place of rest or a place for drug addicts or alcoholics.
• Retirement homes, congregate living, senior housing, or other facilities primarily intended to provide residential services but not maintenance or personal care do not typically qualify as an assisted living facility.
• If institution has multiple licenses or purposes, only sections of institution specifically meeting definition of assisted living facility qualify as an assisted living facility.

Question 6

Automatic Inflation Protection

Answer 6

• Feature helps coverage keep pace with rising cost of inflation.
• Every year, benefit amount and maximum lifetime benefit automatically increases by a fixed percentage (typically 5%), which may be compound or simple.
• Increase continues for life of Policy, even when insured receives benefits.
• Initial premium for this option is higher; however, premium is designed to remain level throughout life of the policy while benefit amount increases.
• While a option for many policies, Employer may or may not offer option to each insured or include in Plan.
• See Optional Inflation Increase feature.

Question 7

Bed Reservation

Answer 7

• Days in which nursing home, hospice, or assisted living facility daily benefit is paid while insured is temporarily in a hospital.
• Most facilities require payment for the bed while individual is in hospital to guarantee an available bed upon return

Question 8

Benefit Duration

Answer 8

• Length of time insurance coverage will last if one receives care every single day at a cost equal to or more than benefit amount insured selected.
• Duration is a dollar amount rather than a number of days or years.
• If cost of services is less than benefit amount, or if insured doesn’t receive services every day, benefits will last longer than selected number of years.
• See Maximum Lifetime Benefit.

Question 9

Buy-Up

Answer 9

• Any type of increase in coverage (DBA, TLB, adding Nonfor, adding Auto infla, etc).
• Increase in coverage automatically creates an increase in premium.
• Therefore, person is paying for, or “buying up”, more coverage.

Question 10

Cancellation

Answer 10

Termination of coverage, either voluntarily or due to non-payment of premiums.

Question 11

Chronic Care

Answer 11

Care required for a long period of time such as medical care or custodial care.

Question 12

Chronically ill

Answer 12

• Insured cannot perform, without substantial assistance from another individual, at least two of six Activities of Daily Living for a period of at least 90 days due to loss of functional capacity.
• To comply with HIPAA, insured must be certified as chronically ill, with ADL dependency expected to last at least 90 days, before receiving benefits.
• Alternately, insured has a severe cognitive impairment requiring substantial assistance to protect such individuals from threats to health and safety.
• Cognitive impairments require same kind of long-term care as physical disabilities, and trigger eligibility for benefits in the same way as inability to perform ADLs.
• A cognitive impairment may occur as part of a disease, such as Alzheimer’s or other forms of dementia.
• 90-day certification period does not apply to cognitive impairments.

Question 13

Custodial Care

Answer 13

• Provides assistance with activities of daily living.
• Most common type of long-term care service rendered.
• Generally performed by a trained aid in a variety of settings.