Long-Term Care insurance helps reduce the financial burden of aging by providing cash

• for expenses such as
  • in-home health-care
  • care in chronic care facilities (nursing home)
  • medical equipment
  • respite care
  • hospice care
  • adult day care
• cause could be an accident, illness (physical or mental), old age or other cause
• benefits payable weekly if
  • cognitive impairment (inability to think, perceive, reason, remember), or
  • unable to perform unaided 2 or more of the 5 Activities of Daily Living (ADLs):
    • bathing, eating, dressing, toileting, transferring of positions of the body
• issue ages: 31-80 or 40-80
• elimination period: 0-180 days
• type of benefit
  1. facility care: indemnity basis (covers the full amount of benefit purchased)
  2. home care: reimbursement of actual costs
• benefit period: three years to life, or a dollar amount (e.g., 100 times the basic benefit)
• premiums
  • guaranteed renewable as for disability insurance (renewable each year; insurer cannot make any changes to the contract; insurer can only increase rates on a class basis due to adverse claims experience)
  • payable for the full term of coverage or a shorter period
• pre-existing conditions: no benefits during the first 6 months of coverage

The conditions to be met for payment of a benefit are in the insurance contract (a contract of adhesion), and may vary among insurers.

Some provinces legally require you to provide varying degrees of parental support

• no requirement in Manitoba, Saskatchewan or Quebec

Activities of Daily Living

The common Activities of Daily Living (ADLs) are

1. bathing
   • washing yourself completely in a tub, shower or with a sponge
   • can be with the aid of equipment
2. eating
   • consuming food that has already been prepared
   • irrelevant whether you can prepare the food yourself
3. dressing
   • both of the following
     1. putting on and taking off your clothing, braces, artificial limbs
     2. securing and removing the clothing or devices
4. toileting
   • all of the following
     1. getting to and from the toilet
     2. getting on and off the toilet
     3. maintaining a reasonable level of personal hygiene
   • can be with the aid of equipment
5. transferring of positions of the body
   • moving in and out of a chair, wheelchair or a bed
   • can be with the aid of equipment (e.g., cane, walker, crutches, and grab bars)

An insured who is unable to perform two or more Activities of Daily Living may be eligible for a benefit

Exclusions

The need for care could be an accident, illness (physical or mental), old age or other cause. However, there is generally no coverage for illness or injuries arising from

1. self-inflicted while sane or insane
2. during military service
3. war (declared or undeclared) or any act of war
4. alcoholism or other drugs unless prescribed by a doctor and under a doctor's treatment
5. nervous or mental disorders without demonstrable organic cause (except for Alzheimer's disease or senile dementia)
6. criminal activity (successful or unsuccessful)
7. AIDS, HIV or Kaposi's sarcoma

Taxation

As for critical illness insurance, The taxation of Long Term Care insurance is unknown. Benefits are likely tax-free when premiums are paid with after-tax dollars.

• interpretation from Sun Life

Other Resources

• Do you care about Long-Term Care?
• Dealing with the staggering cost of dementia
• Long term care takes planning (Financial Post, Oct 2012)
• Women face a new long-term care dilemma (MarketWatch, Mar 2013)
• Long-term care insurance can be expensive (Moneyville, Dec 2012)
• Long-Term Care: Let's have an adult conversation before it's too late (Toronto Star, Nov 2012)
• Demystifying long-term care (Forbes, Nov 2011)
• Does long-term care insurance make sense? (LifeHealthPro, Oct 2012) [written for advisors]
• Videos and case studies (Life Foundation)
• insurer microsites (no endorsement implied): Manulife (includes videos), RBC, Sun Life