Long-Term Care and Other Health Insurance
Core concepts
Long-term care (LTC) insurance pays for custodial care when the insured cannot perform activities of daily living (ADLs) - bathing, dressing, eating, toileting, transferring, continence - or has cognitive impairment. Candidates must know ADL triggers, elimination period, benefit amount, inflation protection, and reimbursement vs. indemnity models.
Other health products include hospital indemnity, dental, vision, prescription drug, and supplementary health plans. Understand exclusions, pre-existing condition clauses, and coordination with provincial health plans.
Traps in questions
- Confusing LTC with disability income - LTC pays for care, not lost wages.
- Assuming provincial health plans cover custodial care - they generally do not.
- Forgetting the elimination period before LTC benefits begin.
- Overlooking inflation protection - without it, benefits erode over time.
Rule of thumb
LTC triggers on inability to perform ADLs (often two of six) or cognitive impairment. If the question mentions nursing home or home care, it is LTC.
Worked example
An insured cannot bathe or dress without help (two ADLs) and enters a care facility. After the 90-day elimination period, the LTC policy pays the stated daily benefit, adjusted for inflation.