Lesson 16 Review
Florida statutes call for all Medicare supplement policies to "contain a prominently displayed no-loss cancelation clause enabling the insured to return the policy within 30 days of the date of receipt of the policy, or the certificate issued thereunder, with return in full of any premium paid."
Florida law requires agents to ask every person solicited whether they are currently covered under any other contracts so they may explain the extent to which the proposed coverage will overlap or duplicate coverage. Before an application is taken, the Department of Financial Services requires that agents obtain a signed form from the applicant acknowledging that this information has been provided.
Long-term care (LTC) is medical care that is needed for an extended period of time, typically longer than 90 days.
Acute illness is a serious condition that with proper medical treatment, the patient should receive full recovery. Chronic illness is a physical condition that is constant in nature and for which there is no full recovery possible.
Medigap policies:
- supplement Medicare benefits;
- pay most, if not all, Medicare deductibles and copayments; and
- pay for some health care services not covered by Medicare.
Skilled nursing care is 24 hours a day, seven days a week (24/7) for nursing and rehabilitative care, is only available by prescription, and is usually administered in nursing homes.
Custodial care is intended to assist with ADLs. Care is usually provided by unskilled nursing assistants in nursing homes, day care centers, and at home.
Home health care is provided to patients while they are still in their own homes and are generally able to function for themselves in most areas. A qualified, but not necessarily medical, person helps in performing the essential ADLs.
Adult day care usually caters to those who are mentally or physically impaired, or when primary caregivers are not accessible. Transportation is provided to and from the facility for social activities, group exercises, therapeutic activities, nutritional education, medical care, meals, speech and occupational and physical therapy.
Respite care is designed to give the primary caregiver a short rest period while still providing the patient with assistance with various ADLs.
Continuing care is designed for seniors in a long-term care community and provides assistance with full time medical and social needs. Retirement communities are often sponsored by religious or nonprofit organizations.
A physical diagnosis would mean that the individual has been certified as unable to perform at least two ADLs. An LTC policy must take into account at least five ADLs.
Chronically ill individuals are those who require substantial supervision to protect their health or safety owing to severe cognitive impairment.
The information contained in Unit 21 of the Florida study manual has been presented in Lesson 16 of the online course.
