Prudential Financial Long Term Care Insurance
The following are Prudential Long Term Care Insurance's standard plan features. You'll have choices to make about each one of them that allow you to tailor coverage to your individual needs. The amount of benefits provided depends upon the plan selected and that the premium will vary with the amount of the benefits selected
Benefit Waiting/Elimination Period
You may choose between elimination periods of 0, 30, 60, and 100 days (not all options are avaliable in all states). It helps to understand that the longer the elimination period, the lower the premium; the shorter the elimination period, the higher the premium.
Lifetime Maximum Benefit
The Prudential Insurance Company of America offers lifetime maximum benefits based on lengths of time equal to 3, 4, or 5 years; lifetime is also available.
Institutional Care Daily Maximum Benefit
The maximum amount the policy will reimburse for institutional care benefits in a single day. You can choose from Institutional Care Daily Maximum Benefit amounts ranging from $50 to $350 per day in $10 increments.
Home and Community-based Care Daily Maximum Benefit
Established as a percentage of the Institutional Care Daily Maximum Benefit. The Prudential Insurance Company of America offers Daily Maximum Benefit amounts for home and community-based care at 50%, 75% and 100% of the Institutional Care Daily Maximum Benefit.
Home and Community based Care Benefit Payment Options
Prudential Insurance Company of America's long term care insurance offers three ways to receive home and community-based benefits: daily benefit, monthly benefit, cash benefit. There are advantages to each of the options.
Inflation Protection Option
You have your choice of three ways to help maintain the value of your insurance over time:
- Periodic: Every three years you will be offered the opportunity to increase your benefits. If you accept the offer, the daily maximum benefit increases by at least 5%, compounded annually. (Added coverage will increase your premium at your attained age.)
- 5% Simple: Benefits automatically increase annually on the anniversary date of the policy; increase will equal 5% of the original Daily Maximum Benefit you select. (Premiums are intended to stay at the same/level.)
The Simple Inflation Protection Option is not available to residents in Delaware, Idaho and Indiana. - 5% Compound: Benefits automatically increase annually on the anniversary date of the policy; increase will equal 5% of the current Daily Maximum Benefit in effect. (Premiums are intended to stay at the same/level.)
Emerging Trends Benefit
This policy provides coverage for a broad range of services including institutional and non-institutional care. However, there are always new, emerging trends in the delivery of long term care. Therefore, The Prudential Insurance Company of America will consider a claim for benefits when care is received in an alternate setting or for services designed to help you remain independent in your home. Determination of benefit eligibility and the benefit amount will be made on an individual basis at the sole discretion of The Prudential Insurance Company of America. To qualify, such care shall be a qualified long term care service within the meaning of Internal Revenue Code 7702B.
Private Care Management Benefit
You and your family may need assistance identifying resources, services and Providers available to meet your specific long term care needs. To aid you in evaluating your options and coordinating your long term care services, you may wish to select your own independent Private Care Manager. The policy provides coverage for up to 20 consultations per Calendar Year with a Private Care Manager. Each consultation is payable up to your Daily Maximum Benefit for Institutional Care. You must meet the Benefit Eligibility Criteria, however, the Benefit Waiting Period does not need to be satisfied to access this benefit.
30 Day Free Look
You have 30 days to review your policy risk free. If you aren't completely satisfied you may return the policy to The Prudential Insurance Company of America or to your agent within the 30?day time period, and any premiums paid will be refunded.
Note: You should consult your tax advisor with respect to the tax implications of ownership of a long term care insurance policy.
Policy Exclusions
This is a general list of exclusions, however, state variations may apply. Your Policy is designed to provide coverage to pay for the long term care you need when you need it. However, there are some special circumstances that limit or exclude the availability of benefits under this Policy. No benefits will be payable if any of the following situations apply.
- Government Plan Charge: A charge for a service or supply:
a) furnished by or for the United States government or any other government, unless payment of the charge is required by law; or
b) to the extent that the service or supply, or any benefit for the charge is provided by any law or governmental plan under which the patient is or could be covered. This (b) does not apply to a state plan under Medicaid or to any law or plan when, by law, its benefits are excess to those of any private insurance program or other non-governmental program. When this (b) applies to Medicare, the benefits provided by Medicare will be deemed to include any amount that would have been payable to Medicare in the absence of a deductible or co-insurance requirement under that program. - War: Charges for a condition due to war or any act of war while you are insured. "War" means declared or undeclared war and includes resistance to armed agression. State of Oklahoma Residents: War: Charges for a condition due to war or any act of war which you are insured. "War" means declared or undeclared.
- Self-Inflicted Injury or Attempted Suicide: Charges arising from intentionally self-inflicted injury or attempted suicide
- Services and Supplies Outside the United States: Charges for services or supplies outside the United States and its possessions.
- Close Relative: Charges for services and supplies furnished and charged for by a close relative other than a licensed professional who provides covered services within the terms of his or her license. Close relatives include you, your spouse or a child, grandchild, brother, sister or a parent of you or your spouse.
- Services or Supplies Normally Furnished Without Charge: Services or supplies for which no charge would be made in the absence of insurance.
- Chronic Alcoholism or Chemical Dependency: Charges in connection with chronic alcoholism or chemical dependency.
- Felony, Riot or Insurrection: Charges for a condition due to your participation in an act of felony, riot or insurrection.
- Charges incurred in excess of any Daily or Monthly Maximum, Calendar Year limit or Lifetime Maximum dollar limit.
- Charges incurred more than seven days prior to the date you are assessed.
- Except for Bed Reservation, Respite Care, Independence Support and Care Consultation, charges incurred which are not included in the Plan of Care.