Long-Term Care Insurance – North Carolina
Long-Term Care Insurance (ICC1197062IC Series)
North Carolina Long-Term Care Insurance is currently available through State Farm® Mutual Automobile Insurance Company. Details about coverage, policies, and benefits are listed below. State Farm has different plans to help you choose the plan to best fit your needs. Please read a brief description of the Long-Term Care Insurance in North Carolina.
The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.
Get a Long-Term Care Quote
Long-Term Care Insurance / Long-Term Care Partnership Insurance
Partnership policies are designed to allow you to protect a portion of your assets after you apply for Medicaid. Confirm with the agent your preference of partnership coverage or non-partnership coverage.
Policy Benefits (Long-Term Care Insurance and Long-Term Care Partnership Insurance)
Home Health Care/Adult Day Care
- Paid on a Calendar Week basis.
- Pays the lesser of seven (7) times the Maximum Daily Benefit or the actual expense incurred during a Calendar Week.
- Pays the lesser of the Maximum Daily Benefit or the actual expense incurred for up to thirty (30) days per calendar year.
Medical Help System
- Pays for rental or lease of the system while your policy is inforce and you are residing in your home.
- Pays the expense incurred, up to 25% of the Maximum Daily Benefit.
- Payable for a maximum of twelve (12) months.
- Pays expenses incurred, up to five (5) times the Maximum Daily Benefit.
Alternate Care Facility (such as Assisted Living)
- Pays the expense incurred for each day, up to the Maximum Daily Benefit.
Long-Term Care Facility (such as a Nursing Home)
- Pays the expense incurred for each day, up to the Maximum Daily Benefit.
- Pays the lesser of the Maximum Daily Benefit or the expense you incur if charged while temporarily absent from a facility.
- Thirty (30) day limit per Calendar Year.
Waiver of Premium
- Premiums are waived after ninety (90) days of covered care, not separated by more than fifteen (15) days.
Alternate Plan of Care
- Arrangements for care in a setting other than a Long-Term Care Facility.
- May allow you to remain in your home.
- Pays the lesser of the Maximum Daily Benefit or the expense you incur.
Home Modification and Durable Medical Equipment
- Physical changes to your home.
- Use of Durable Medical Equipment.
- Allows you to remain in your home.
- Pays a maximum of fifty (50) times the Maximum Daily Benefit.
- Your Maximum Daily Benefit can be increased in one of the following ways:
- Future Purchase Option (ICC1197062IC)
Simple Automatic Increase Benefit (ICC1197062SIC)
Compound Automatic Increase Benefit (ICC1197062CIC)
General Description of Benefits
To be eligible for benefits, you must first be "Chronically Ill" as certified by a Licensed Health Care Practitioner (a physician i.e., M.D. or D.O., registered nurse, or licensed social worker).
Certification means that you are unable to perform at least two Activities of Daily Living for an expected period of at least 90 days without substantial assistance from another person. You must also satisfy an Elimination Period before benefits are paid.
What are Activities of Daily Living?
- Eating (feeding yourself; not meal preparation)
- Bathing (washing yourself)
- Toileting (using the bathroom)
- Dressing (putting on and taking off clothing)
- Continence (controlling bladder and bowel function or the ability to perform hygienic tasks if control is lacking)
- Transferring (moving into or out of a bed, a chair or a wheelchair)
You could also be certified as Chronically Ill if your health and safety are threatened and you need substantial supervision because of a severe cognitive impairment (such as Alzheimer's disease).
What is an Elimination Period?
The Elimination Period is similar to a deductible under other types of insurance policies. It is the number of days you receive and pay for eligible care before you begin receiving policy benefits. In most states you can choose 30, 90 or 180 days. After satisfaction of the Elimination Period, benefits will be paid for each day of care, for charges incurred up to the daily benefit amount in your policy.
Is there a maximum benefit?
Yes. Daily benefit amounts range from $100/day up to $500/day; in $25 increments.
The Maximum Lifetime Benefit is equal to the daily benefit; multiplied by 365 days, multiplied by the benefit factor (in years) you choose when you apply for the policy. The benefit factor can be 2, 3 or 5 years. For example, a $100/day policy with a 5 year benefit factor has a lifetime maximum of $100 X 365 days X 5 years = $182,500.00.
The Maximum Lifetime Benefit can be restored if you are no longer Chronically Ill and do not need otherwise covered care for 180 consecutive days.
Waiver of Premium
After 90 days of covered care, not separated by more than a 15 day period, your premiums will be waived. You will not be responsible for premium payment unless you recover or are no longer receiving covered care, or if your policy's lifetime maximum has been met.
What types of care are covered?
Eligible care can be received in your home, the community or in a facility. These include:
- Respite Care (temporary relief for an informal, non-licensed unpaid caregiver)
- Medical Help System (a communication system used to summon attention in a medical emergency)
- Caregiver Training for informal unpaid caregivers in your home
- Home Health Care, including Hospice
- Community-based care, including Adult Day Care
- Alternate Care Facilities, such as Assisted Living
- Long-Term Care Facilities, such as Nursing Homes
- Bed Reservation, to hold your room if you are temporarily absent from a covered facility
- Alternate Plan of Care (possible alternative care options when you would normally require care in a covered Long-Term Care Facility)
- Home Modification and Durable Medical Equipment (possible physical modification to your home and/or certain pieces of Durable Medical Equipment when you normally would require care in a covered Long-Term Care Facility)
Pre-existing Condition Limitation. We will not pay for a loss due to a Pre-existing Condition which You did not disclose in the application unless the loss begins more than six (6) months after the Effective Date of Coverage. However, providing incorrect information may cause Your policy to be voided. If this policy replaces another Long-Term Care Insurance policy, the six (6) month time period above is waived to the extent it has been satisfied under the replaced policy.
Grace Period. You are allowed a 65 day grace period for late payment of each premium due after the first premium. Your policy will remain in force during this period.
If You do not pay Your premium by the end of the grace period, Your policy will terminate.
GUARANTEED RENEWABLE FOR LIFE — PREMIUMS SUBJECT TO CHANGE
Your policy will remain in effect during Your lifetime as long as each premium is paid on time. We cannot cancel or refuse to renew Your policy. We cannot change Your policy without Your consent. However, We may change the premium rates. Any change will apply to all policies in the same class as Yours in the state where the policy was issued. We will notify You in writing 60 days before Your premium changes.
We provide a refund of unearned premium when We are notified of Your death or You exercise Your right to request cancellation.
This Policy is intended to be federally tax-qualified.
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The quotes generated by this program are illustrative only and not a contract, binder or agreement to extend insurance coverage and are based on information you have supplied. If the information used to generate this example changes, or different rates are effective at the time of policy issuance, this rate quote may be revised. Premium rates are subject to change and may be increased, and any rate changes would apply to all policies in the same class in the state where the policy is issued. No money should be sent to State Farm in response to this advertisement. To obtain coverage you must submit an application to State Farm. All applications for coverage are subject to underwriting approval and subject to applicable state and federal law. Upon application approval, coverage can only be effective after payment and receipt of the initial policy-required premium. All policies may not be available in all states. Benefits, exclusions and limitations will apply. Please contact a State Farm agent/producer for further details.
Note: This is a marketing tool intended for use in the sale of insurance. Completion of an application for a State Farm insurance policy will require contact with a State Farm insurance agent/producer.
No Medical Exam is required.
The information provides a brief, general description of the coverage provided by these policies. It is not a contract and certain exclusions and limitations apply. A complete statement of the coverage provided is found only in the policy itself. Policy coverage's, exclusions and limitations may vary in some states.
For exact terms and conditions see: Long Term Care Policy series ICC1197062IC.