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LONG-TERM CARE
Prudential LTC by Design
Underwritten by The Prudential Insurance Company of America.
The Prudential Insurance Company of America is rated "A+ Superior" by A.M. Best
for financial strength.
- Availability
- Policy Maximum Benefits
- Elimination Periods
- Benefit Trigger
- Accessing Benefits - Activities of Daily Living Triggers & Cognitive Impairment
- Benefit Description
- Alternate Plan of Care
- Waiver of Premium
- Inflation Protection
- Other
Availability
Available in all states. Member must meet health guidelines to qualify.
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Policy Maximum Benefits
Coverage under the plan creates a flexible "pool" of benefit
dollars for each covered member that can be accessed at claim time to
cover the necessary treatment. The insured tailors his/her policy to address
his/her own needs and concerns. The Daily Benefit Amount is $50 to $500 daily in $25 increments.
Lifetime Maximum Benefit: 2, 3, 4, 5, or Unlimited years. (ages 80-84, 3 or 4 years)
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Elimination Periods
As in most insurance products, long term care insurance also has deductibles.
For long term care, these deductibles are called "Elimination Periods."
The first days of coverage that are not covered by the policy are the
Elimination Period. The insured may choose either 30, 60, 90 or 180
days. All Elimination Periods are applied only once in a lifetime.
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Benefit Trigger
Chronically Ill and Disabled ("Disabled" means unable to perform
two of the six Activities of Daily Living or Cognitively Impaired.)
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Accessing Benefits - Activities of Daily Living Triggers & Cognitive
Impairment
In order for a plan to be tax-qualified, the minimum triggers for accessing
benefits are "substantial assistance" ("stand-by" or "hands-on") with two out of six activities
of daily living. These activities are eating, bathing, dressing, toileting,
transferring, and continence.
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Benefit
Description
Nursing Home, Assisted Living or Hospice Care:
covered at 100% of benefit amount. Bed Reservation benefit of 21 days per year for hospitalization.
Home Care, Skilled Home Care or Informal Home Care: choice of 50%, 75% or 100% of facility benefit
when care provided by Home Health Care Agency or Certified Home Health Care Provider.
Adult Day Care: choice of 50%, 75% or 100% of facility benefit.
Respite Care: Up to 21 days annually. Subject to Elimination Period and reduces Lifetime Maximum.
Pays 100% of facility amount.
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Alternate
Plan of Care
Covered under Emerging Trends Provision that may apply while receiving a benefit.
Subject to the Elimination Period and reduces Lifetime Maximum.
If agreed to by you, your licensed health care practitioner
and the company, the company may pay for equipment and services not specifically covered.
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Waiver of Premium
Available the month following satisfaction of the Elimination Period.
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Inflation Protection
Periodic, simple, compound and compound with 2x cap. Maximum Daily Benefit and remaining Lifetime Maximum
will increase accordingly.
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Other
Coverage/product may vary by state.
Age/benefit restrictions may apply.