She Thought She Was Fully Insured... The Elimination Period Proved Otherwise.
Long Term Care policyholders never realize how specific policy language can affect their policies — until they learn how it can affect a claim. My Policy Advocate™ helps you understand your coverage before you need it.
The Miller Family’s 90-Day Shock*
Margaret Miller paid premiums for 15 years. When she needed a home health aide after a fall, the family expected their $350/day benefit. The claim was approved, but benefits only began after the 90-day elimination period. This un-explained waiting period cost the family $27,000 out-of-pocket, consuming most of Margaret’s savings before coverage began.
Potential Denial (The Gap):
The elimination period functioned as a massive, time-based deductible, resulting in immense, unexpected up-front out-of-pocket loss.
Risk Identified by My Policy Advocate:
Waiting period and out-of-pocket exposure.
Policy Language:
“Benefits will begin after you have satisfied the Elimination Period… 90 consecutive days.”
Discovery by Clara, our Ai Assistant:
Clara flags the length and definition of the elimination period, calculating the total out-of-pocket cost based on the daily benefit/cost of care.
Questions to Ask Your Agent:
- Is my elimination period calendar days or days of paid care?
- What is my real out-of-pocket risk up front, and is a shorter period available?
* This scenario described is fictious and is solely for illustrative or educational purposes so the insured has the opportunity to discuss these issues with their licensed insurance producer.
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