Short-Term Care Insurance

Every benefit below is transcribed from ManhattanLife OmniFlex Short-Term Care brochure STC-BR 0525, and from the Nevada outlines of coverage AL7060OCNV and AL7060IOCNV (the second is the version with Simple Inflation), the application for short-term care insurance AL7060APNV. Benefits, amounts and riders vary by state; the policy issued to you governs.

• Read this first: you do not get the daily benefit you chose until year five Included

  The amount that actually pays a claim is the Accrued Daily Benefit, and it starts at 50% of the daily benefit you elect. It rises on each policy anniversary and reaches the amount you chose on the fifth one. A $400 election pays $200 a day in year one.

  The brochure carries this in small type under three asterisks. It is first here because it is the difference between what the application says and what a claim in year two pays, and because nothing else on this page matters as much if you get it wrong.

• Facility care — the base policy Included

  A per day cash benefit for care in a nursing home or facility, an assisted living facility or a hospice facility. Choose a daily benefit from $50 to $400 in $10 steps, an elimination period of 0, 20, 60 or 90 days, and a benefit period of 90, 180, 270 or 360 days. The lifetime maximum benefit period is twice the benefit period you chose.

  A physician must certify Loss of Functional Capacity, Cognitive Impairment or Terminal Illness, the care must be in your plan of care, and only one benefit is payable in any one day however much care you receive. The 360 day benefit period is not offered in Idaho.

• Fast-50 — first-day cash, and your own family may provide the care Included

  Take Fast-50 instead of the standard benefit and the elimination period is waived entirely, payment starts on day one, and the benefit is 50% of your accrued daily benefit. On the home health care rider it also lifts the rule that bars care from an immediate family member or friend — both medical home health care from a family member who is a practitioner and non-medical homemaker services from a family member or friend become payable.

  You can switch back to the full benefit later, but the elimination period then has to be satisfied. This is the feature that separates the product from the other short-term policies on this site: it pays from day one and it pays when the carer is your spouse.

• Bed reservation Included

  If you are admitted to hospital while living in a nursing home or assisted living facility, the policy keeps paying your daily benefit to hold the bed for up to 10 days, with a lifetime maximum of 20 days.

  Payable only if you go straight back to the same facility after the hospital discharges you.

• Prescription drugs Included

  $10 for each generic and $25 for each brand-name prescription, to a policy year maximum of $300.

  Two unusual things about this one: it is not subject to the pre-existing conditions limitation, and you do not have to be receiving any care under the policy to claim it. Drugs from outside the United States are excluded, except from Canada.

• Restoration of benefits Included

  After 180 days in which no care is needed and no benefit is paid, the facility care or home health care benefit period restores — and keeps restoring until the lifetime maximum has been paid out.

  The lifetime maximum is the real ceiling, not the benefit period. Once it is reached, benefits stop for good.

• Home health care rider Optional rider

  A per day benefit for care at home: nursing care including a home health aide, physical therapy, speech pathology, occupational therapy, chemotherapy specialist services, enterostomal therapy, respiratory therapy, medical social services and non-medical homemaker services. Choose $50 to $300 a day in $10 steps, with the same elimination periods and benefit periods as the base policy, and a lifetime maximum of twice the benefit period.

  Without Fast-50 this rider does not pay for care given by an immediate family member or a friend. With Fast-50 it does, at half the accrued rate. Which of those is worth more depends entirely on who would actually be looking after you.

• 5% simple inflation rider Optional rider

  From the sixth policy anniversary the daily benefit grows by 5%, and then by that same dollar amount on every anniversary through the twenty-fifth, until the daily benefit has doubled. It applies to facility care and, if you took the rider, to home health care too.

  The increase is simple rather than compound — the same dollar figure each year, not 5% of a growing number. The benefit payable is the one in force on the first day of a period of care and does not rise during that period. It is also the first thing the underwriting takes away: a yes to any second-set health question removes it.

• Hospital indemnity rider Optional rider

  A per day cash benefit for inpatient hospital room and board, $50 to $300 a day, over a benefit period of 3, 6 or 20 days, with a lifetime maximum of 180 days. It pays on top of any other coverage, including intensive care, neonatal and coronary units and step-down units.

  Not payable for confinement in a rehabilitation unit, and the rider carries a long exclusion list of its own — among it, spinal injuries unless the loss begins at least six months after the effective date, hernias, tendinitis and bursitis, a list of hazardous occupations, and injuries more than forty miles outside the United States or Canada unless you are on a trip of no more than sixty days.

Issue ages

45 to 89. A 10% discount applies if you live with a legal spouse who holds, or is applying for, a short-term care policy with the same company. In Nevada that means a spouse or a domestic partner.

Underwriting

Simplified issue, and the application decides three separate things. Five knock-out questions make you ineligible outright: HIV, current Medicaid eligibility or early Medicare through disability, currently needing help with activities of daily living or being in a facility or already receiving home health care, a diagnosis of Alzheimer's, dementia, stage 4 or 5 Parkinson's, Huntington's or cognitive impairment, certain diabetic complications, tests or surgery advised in the past 12 months and not yet done, and cancer other than skin cancer in situ in the past 24 months. A second set of questions does not decline you but caps you: answer yes to any of stroke, TIA, congestive heart failure, an organ transplant, heavy insulin use, a named neurological condition, amputation caused by disease or chronic lung or liver disease in the past 24 months, and the simple inflation benefit is off the table and every daily benefit is capped at $100. Prescription medication in the past 24 months is listed with its diagnosis, and tobacco use in the past 24 months is asked.

Renewability

Guaranteed renewable, with 30 days to return the policy for a full refund. A one-time $25 policy fee applies. The company may change the premium only for every policy of the same form and rate class in your state, and only on at least 60 days' written notice.

Pre-existing conditions

Six months. A pre-existing condition is not covered for the first six (6) months you are insured, whether or not it was disclosed on the application, and conditions named as excluded anywhere in the policy are never covered. The prescription drug benefit is not subject to the pre-existing limitation. Transcribed from the Nevada outlines; the period may differ in another state.

Policy form

AL7060, AL7060I. Rider forms AL7060HC, AL7060IH, AL7060HR. Form numbers and benefits vary by state.

Every benefit below is transcribed from the Aetna Recovery Care Choice outline of coverage CLIRE08515NV (Nevada edition), for policy form CLIRECC025NV, and from the Aetna Recovery Care Choice brochure CLIRE08671, the Aetna Senior Supplemental Insurance company profile CGFMP08395, which states the A.M. Best rating and its date. Benefits, amounts and riders vary by state; the policy issued to you governs.

• What triggers a claim: two of six activities, or cognitive impairment Included

  The daily nursing facility and assisted living benefit is payable once the carrier receives documentation establishing that the insured cannot perform two or more of the activities of daily living, or has a cognitive impairment.

  Acceptable documentation may include a Comprehensive Minimum Data Set assessment within the first fourteen days of a confinement, or another written assessment where the facility is not Medicare or Medicaid certified. The carrier may re-assess, generally not more than once in any ninety day period.

• The daily benefit, and what you choose Included

  Pays a daily amount for nursing facility or assisted living confinement, up to a maximum of $700 a day, with a choice of 90, 180, 270 or 360 covered days and a choice of a 0, 20 or 100 day elimination period. Memory care is included. The lifetime maximum is equal to twice the number of covered days.

  The elimination period has to be met before benefits are paid and is satisfied only once in the lifetime of the policy — not once per claim.

• It pays for custodial care, and the facility need not be Medicare approved Included

  The daily nursing facility coverage pays for all levels of nursing facility care — skilled, intermediate and custodial — and for services in an assisted living facility. The facility does not have to be approved by Medicare.

  This is the gap the policy exists for. Medicare pays for the first 20 days of skilled care only, and only after an inpatient admission of at least three days; it pays nothing for intermediate or custodial care, and nothing for an assisted living facility.

• Bed reservation Included

  Pays to reserve the insured's bed during a covered nursing facility or assisted living confinement when the insured is admitted to hospital as an inpatient.

  It is not payable unless, on discharge from hospital, the insured returns immediately to the facility they were in before.

• Prescription drugs Included

  Pays toward prescription medication needed to treat a covered illness or injury while the policy is in force: $10 per generic prescription and $25 per brand name prescription, to a $300 annual maximum.

  This is the one benefit the pre-existing condition limitation does not apply to.

• A Medicare Part B excess charge benefit, inside a short-term care policy Included

  Pays 100% of the difference between what Medicare pays and the amount charged by the provider, which shall be no greater than the actual charge or the limiting charge allowed by Medicare, whichever is less. The claim must be for Medicare Part B.

  This is a Medigap-shaped benefit in a policy that is not a Medicare Supplement and is not a substitute for one. It is unusual and it is worth asking about, but do not let it stand in for a Medigap policy — it covers excess charges and nothing else Medicare leaves you.

• Optional rider: home care, and family can be paid for it Optional rider

  Pays a weekly benefit when the insured receives at least three home care service visits per week, of at least one hour each, in their home from a home care provider. Up to $2,100 a week, with a choice of 13, 26, 39 or 52 weeks, a 0 or 20 day elimination period, and a lifetime maximum equal to twice the number of covered weeks.

  Family and friends can receive 25% of the weekly home care benefit if they provide the home care services, and the agency does not have to be approved by Medicare. Without this rider, home health care is excluded from the policy entirely.

• Optional rider: daily hospital confinement Optional rider

  Pays a daily amount for hospital confinement including observation stays, up to $700 a day, with a choice of 3 to 10 or 20 days per period of care and a lifetime maximum of 365 days. An observation stay of less than 24 hours pays 50% of the daily hospital confinement benefit, once per period of care.

• Optional rider: adult day care Optional rider

  $50, $100 or $150 a day for health-related services, social engagement and physical activities at an adult day care centre, up to 30 visits a year. The same two-of-six activities or cognitive impairment test applies.

• Optional rider: inflation protection Optional rider

  Increases the daily nursing facility benefit on each policy anniversary, starting one year after the rider's effective date, by a choice of 3% or 5%, on a simple or compound basis. The increases continue whether or not you are claiming.

  It applies to the daily nursing facility benefit only, not to the other riders, unless a rider says otherwise. During a period of care the amount payable is the amount in force when the loss was incurred.

• Optional riders: the rest of them Optional rider

  Home modification, $2,500 lifetime maximum, payable while you are receiving the nursing facility or home care benefit. Mental health visits with a licensed professional, in office or by telehealth, at $25, $50, $75 or $100 per visit, 20 visits a year. Outpatient rehabilitation at $50, $100 or $150 a day, 15 or 30 visits a year. Ambulance transportation at $200, $400 or $600 per ride, 4 uses a year. Pet boarding at $50, $75 or $100 a day, 30 days per period of care, while you are confined to a nursing home.

  Mental health visits are covered by that rider even though mental and nervous disorders are excluded from confinement benefits. Preventive care visits are not covered under it.

• What the policy will not pay for Not covered

  Confinement for experimental or investigational procedures and clinical trials, mental or nervous disorders and substance use disorders, obesity and weight reduction including bariatric surgery and its complications, tobacco cessation, and learning disorders, developmental delays or sleep disorders. Outpatient treatment, services or supplies of any type, except those payable under the prescription drug benefit, the Medicare Part B excess charge benefit and the outpatient rehabilitation, ambulance and mental health riders. Confinement in a hospice care facility. Home health care, unless the home care rider is attached. A stay in a community living center or a place that primarily provides domiciliary, retirement or educational care. War, riot or international armed conflict. A lawful conviction following a crime or felony, or an illegal act, or time imprisoned — excluding acts related to domestic violence. Suicide or intentionally self-inflicted injury, sane or insane. Skydiving, scuba diving, hang or ultra-light gliding, ballooning, bungee jumping, parakiting, riding an all-terrain vehicle, racing, sports for pay or profit and rodeo contests. Injury sustained while driving over the legal blood alcohol limit. Confinement outside the United States.

Issue ages

40 to 89, age at signature date.

Renewability

Guaranteed renewable for your life provided premiums are paid when due, subject to the policy termination provisions.

Pre-existing conditions

Pre-existing conditions are not covered by the policy or any attached rider, whether disclosed in the application or not, for the first 6 months from the date you become insured. A pre-existing condition is a sickness or injury for which medical care, treatment, diagnosis or advice was received or recommended in the 6 months before the effective date, or a condition that manifested itself in those 6 months in a way that would cause an ordinarily prudent person to seek medical advice. The prescription drug benefit is not subject to this limitation.

Financial strength

Rated “A” (Excellent) by A.M. Best as of 13 March 2024 — the third highest of sixteen ratings, which is the part the letter on its own does not tell you. It is a view of the insurer’s ability to pay claims, not a comment on this policy, and it can be changed at any time.

Policy form

CLIRECC025NV. Form numbers and benefits vary by state.