Glossary Terms H-M

Question 1

HIPAA

Answer 1

• Health Insurance Portability and Accountability Act (HIPAA)
• Federal legislation enacted January 1, 1997 and designed to encourage people to take responsibility for long-term care needs.
• Legislation states, for federal income tax purposes, long-term care insurance should generally be treated like accident and health insurance.
• Allows, for federal income tax purposes, deduction of eligible portion of premiums for qualified long-term care insurance.
• Excludes “qualified” long-term care insurance benefits from taxable income.
• Defines features of a “qualified” long-term care insurance plan
• See Tax Qualified Plans.

Question 2

Home Health Aide

Answer 2

• Individual whose main job function is to provide assistance with activities of daily living and whose services are arranged and supervised through a licensed home health care agency.
• If a state or local licensing/certification is required, person must be licensed/certified as a home health aide where service is performed.

Question 3

Home Health Care

Answer 3

• Skilled nursing care, therapy, or home health aide services received at home on a part-time or full-time basis.
• Care may be provided by a licensed nurse (Registered Nurse (R.N.), Licensed Vocational Nurse (L.V.N.), Licensed Practical Nurse (L.P.N.)), home health aide, homemaker, or physical, occupational, respiratory, or speech therapist from a licensed home health care agency.

Question 4

Hospice Care

Answer 4

• Services, provided by a facility (hospice), primarily intended to provide pain relief, symptom management, and support services for terminally ill patients and their families.
• A qualified hospice care facility, unit of facility, public or private agency or subdivision of a public or private agency must either:
• Meet federal certification requirements as a hospice.
• Be comparably licensed under applicable state laws to provide care for, or management of, terminally ill.

Question 5

Independent Provider

Answer 5

• An Independent Provider is someone who is a licensed caregiver, but not part of an agency. They would not be a family member, friend, etc. but someone licensed to provide home care services in a formal capacity such as a nurse, therapist, etc.

Question 6

Inflation Protection

Answer 6

Feature or option increasing value of coverage over time, to keep pace with inflation and rising cost of care.

Question 7

Informal Care

Answer 7

• Care received at home from family members, friends, neighbors or relatives who are not licensed healthcare professionals.
• Can also be included in respite care/services benefit.
• Informal care services usually do not count toward waiting period.
• Feature varies based on plan specifics.
• Not all plans cover informal care.
• Many plans that include informal care cover it on a limited basis,

Question 8

Informal Caregiver

Answer 8

• Person providing custodial (personal) care, whose services are not provided and/or supervised by a home health care agency, nursing home, assisted living facility, hospice, or adult day care center or care management organization.
• Members of insured’s immediate family may qualify as informal caregivers.
• Feature varies based on plan specifics.

Question 9

Licensed Health Care Practitioner

Answer 9

• A Physician, any registered professional nurse, a licensed social worker, or other person who meets such requirements set by U.S. Secretary of the Treasury.
• For the purpose of definition, “social worker” includes any social worker issued a license, certificate, or similar authorization to act as a social worker by a jurisdiction (or by a body authorized by a jurisdiction).

Question 10

Long Term Care (LTC)

Answer 10

• Health and support services available to elderly, chronically ill, and/or disabled, on a long-term basis to help them live independently.
• Services may be received at home, within community, or in nursing home.

Question 11

Maximum Lifetime Benefit (MLB) (Total Lifetime Benefit (TLB) )

Answer 11

• Total amount of money in benefits that MetLife will pay for charges incurred for covered services
• Not including initial care advisory visit and transition expense benefit.
• Shown on insured’s schedule of benefits.
• Changes if daily benefit is changed.

Question 12

Medicaid

Answer 12

• Federal/state public assistance program, which provides for medical needs of people with limited incomes and assets.
• Before qualifying for Medicaid, applicant must meet federal poverty guidelines for income and assets and may have to “spend down” or use up a majority of assets on health care expenses.
• Coverage, income, and savings limitations vary from state to state. (Called Medi-Cal in California)

Question 13

Medicare

Answer 13

• Established by Congress in 1965 as Title XVIII of the Social Security Act.
• A Federal health insurance program for older and certain disabled Americans
• Wholly funded by the Federal government with no state participation.
• Designed to cover patient’s short-term medical (acute) care and treatment.
• Not designed to cover costs of long-term care (custodial) services.
• Generally, Medicare pays for skilled care in a skilled nursing facility following a three-day prior hospitalization as long as individual is under a doctor’s plan of care.
• If above requirements are met, Medicare pays for up to 100 days of care.
• Medicare pays first 20 days of care in full.
• Afterwards, insured is responsible for a co-payment of $114.00 per day for days 21 through 100.
• Medicare also provides some coverage for Home Care if there is a skilled need and person is homebound.
• Medicare offers no provision to cover custodial care, the type of long-term care most people need.