Merritt Personal Lines Manual: Other Provisions to Consider
The waiver of premium provision is fairly standard. Most LTC policies provide that after you are confined to a nursing home and receiving benefits for at least 90 consecutive days, the policy premium will be waived for the duration of the confinement, as long as benefits continue to be paid.
The recurring provision found in LTC policies is similar to relapse insurance. Under this provision, if you are released from a nursing home and are readmitted within 180 days due to the same or a related condition, the second admission (the relapse) will be considered a continuation of the previous nursing home stay. However, if more than 180 days has elapsed since you were released from the facility, you'll have to wait out a new elimination period (EP) but, on the positive side, you also start a new benefit period.
For example, Mary Beth, age 72, has an LTC policy with a 30-day EP and a three-year benefit period. Her daily benefit is $100. Mary Beth is admitted to a nursing home to recuperate from hip surgery. She is in the facility for a total of four months, at which point she is released. However, three months later, she undergoes surgery again on the same hip and returns to the nursing home to recuperate.
Mary Beth's second admission is within 180 days of her discharge from the first stay and it is for the same condition: hip surgery. Under the recurring provision, the second admission is nothing more than a continuation of her first claim. During her first stay, she satisfied the 30-day EP and received daily benefits. Therefore, no new EP is required and she will continue to receive $100 per day for the balance of the benefit period, if necessary.
