Short-Term Home Health Care Insurance

Every benefit below is transcribed from GTL Short-Term Home Health Care brochure GAD15.1-23 (Rev. 5/24) 15B644. Benefits, amounts and riders vary by state; the policy issued to you governs.

• Home health care daily benefit Included

  A daily cash benefit for covered home health care. Combined daily maximum of $150 on Plan A, $300 on Plan B and $450 on Plan C, across skilled and general nursing, physical, speech, occupational, chemotherapy, enterostomal and respiratory therapy, medical social services and a home health aide. Maximum benefit period 360 days.

  In ID the maximum benefit period is 280 days.

• Home health care aide benefit Included

  $50, $100 or $150 a day by plan. No prior hospital stay is required.

  Counts toward the combined daily maximum.

• Prescription drug benefit Included

  $10 for each generic and $25 for each brand-name prescription, up to $300, $600 or $900 a policy year by plan.

• Family caregiver benefit Included

  A $3,500 lump sum once a home health care claim is approved and your family caregiver has registered and completed a caregiver assessment with TCARE. Payable to you, or assignable to your caregiver.

  Benefits assigned to an informal caregiver may have tax consequences for that person. GTL and its agents do not give legal, financial or tax advice.

• Restoration of benefits Included

  Benefits restore after 180 consecutive days without covered services, once a licensed health care practitioner certifies you have recovered sufficiently to no longer need home or nursing care.

• Accident and sickness hospitalization rider Optional rider

  Up to $300 a day by plan for hospital confinement of at least 24 hours, over a 3-day or 6-day benefit period, restoring after 60 days.

  ID and PA include a reduced daily benefit for the remainder of a 31-day maximum benefit period.

• Ambulance rider Optional rider

  $200 for ground ambulance to or from a medical facility, up to four times a year, $2,500 lifetime. No hospital confinement required.

• Return of premium rider Optional rider

  Returns premiums paid, less benefits paid, on your death.

  Not offered by GTL in Georgia, Tennessee.

• Dental and vision rider Optional rider

  Up to $400, $800 or $1,200 a year for a licensed dentist, ophthalmologist or optometrist after the first year, including $200 toward prescription glasses or contact lenses.

  Not offered by GTL in Colorado, Georgia, Tennessee.

• Critical accident rider Optional rider

  After an emergency room visit, a lump sum by injury: accidental death $5,000 or $10,000; hip or skull fracture $1,250 or $2,500; hip dislocation $1,000 or $2,000; knee dislocation or ligament tear $500 or $1,000; other fracture $250 or $500.

  Not offered by GTL in Colorado, Tennessee.

Pre-existing conditions

Coverage is subject to a pre-existing condition limitation. (In NC, no pre-existing condition limitation for ages 65 and older.)

Policy form

G2370. Rider forms RG23CG, RG16ASH, RG15RPDL, RG15CA, RG16ASB, RG12DV. Form numbers and benefits vary by state.

Every benefit below is transcribed from ManhattanLife Home Health Care Enhanced brochure HHCE-BR 0326, and from the outline of coverage AS7008OCNV (Nevada edition), the application for home health care insurance AM7008APNV. Benefits, amounts and riders vary by state; the policy issued to you governs.

• Home health care, by the day Included

  A daily cash benefit for covered care in your home from an approved home health care practitioner, capped at a daily maximum aggregate of $150 on Classic, $300 on Premier and $450 on Deluxe, over a maximum benefit period of 365 days. Inside that aggregate the schedule pays per day, by plan: nursing care $75, $150 or $200; physical therapy, speech pathology and occupational therapy $75, $150 or $200 each; chemotherapy specialist services $60, $120 or $200; enterostomal therapy $50, $100 or $200; respiratory therapy $50, $100 or $200; medical social worker services $100, $200 or $300; and a home health care aide $50, $100 or $150.

  The maximum benefit period may vary by state. Each line is capped by the combined daily maximum rather than paid on top of it, and only one home health care aide benefit is payable in any 24-hour period however much care is given that day.

• Homemaker services — which your own family may provide Included

  $25 a day on Classic, $50 on Premier and $75 on Deluxe for help around the house, to a policy maximum of $4,000, $5,000 or $6,000. The outline of coverage says this may be provided by any individual, including immediate family members, and does not require professional certification.

  You must also be eligible for the home health care benefit, and before a day is paid a physician must certify that you have loss of functional capacity, have cognitive impairment, or are terminally ill. One benefit per 24-hour period.

• Prescription drugs Included

  $10 for each 30-day generic prescription and $25 for each 30-day brand-name one; $30 and $75 respectively for a 90-day supply. The policy year maximum is $300 on Classic, $600 on Premier and $900 on Deluxe.

  The pre-existing conditions limitation does not apply to this benefit. Drugs obtained from outside the United States are not covered, nor are vitamins, herbal or homeopathic products, minerals, appetite suppressants, dietary supplements, nutraceuticals or medical foods. The brochure says the prescription drug benefit is available in most states, so confirm it is available in yours.

• Restoration of benefits, with no limit on how often Included

  If you exhaust the maximum benefit period or the policy maximum and then recover, they restore in full. Two conditions: 180 consecutive days without receiving these services at home, and a physician certifying that you have recovered sufficiently, no longer require any services, and have not been advised to obtain them.

  The outline of coverage states there is no limit to the number of times this may happen. That is worth comparing against a policy with a lifetime cap before you choose between them.

• Routine annual physical examination rider Optional rider

  $150 for a routine annual physical examination, one per policy year.

  Waiting period: 12 months.

• Accidental death and dismemberment rider Optional rider

  $10,000 on accidental death. For dismemberment: sight in both eyes $5,000; sight in one eye $2,500; multiple hand, arm, foot or leg $5,000; a single one $2,500; multiple fingers or toes $500; a single one $250. Death or the loss must occur within 90 days of the covered accident and while the policy and rider are in force. Lifetime maximum $10,000.

  Only the highest single benefit is payable per accident, and where death and a dismemberment result from the same accident only the death benefit is paid.

• Home medical equipment rider Optional rider

  $100 for each piece of home medical equipment your physician prescribes while you are receiving home health care, to a lifetime maximum of $500. What counts is a closed list: mobility assistance (wheelchairs, walkers, rollators, canes, crutches), transfer aids (gait and transfer belts, benches, boards, mats), bathroom safety (shower chairs, elevated toilet seats, commode chairs), home accommodations (hospital beds, patient lifts, trapezes) and personal medical equipment (arm, leg, back and neck braces).

  The equipment must be the most appropriate model that meets your medical need, measured by Medicare guidelines. A replacement is covered only for a material change in clinical status or ordinary wear and tear, a duplicate never is, and unused benefit does not carry forward into another policy year.

• Ambulance rider Optional rider

  $200 for each one-way trip by professional ambulance for emergency care, or between medical facilities where health care is provided during the journey. Four trips a year, lifetime maximum $2,500.

  Not covered where the ambulance is used for your own, your family's or a provider's convenience.

• Accident expense rider Optional rider

  Two options, chosen at application. Option 1 pays a maximum of $1,250 per covered accident and Option 2 pays $2,500. Within that: hip or skull fracture $1,250 or $2,500; hip dislocation $1,000 or $2,000; knee ligament or meniscus tear $500 or $1,000; knee dislocation $500 or $1,000; all other fractures $250 or $500. Lifetime maximum $10,000.

  You must be diagnosed and treated by a licensed health care practitioner in a hospital emergency room, urgent care facility or physician's office within 48 hours of the accident — the outline of coverage shows that window written as 24, 48 or 72 hours depending on the policy schedule, so check the one you are issued. Nothing is payable for a fractured finger, toe, rib or coccyx, or a chipped, fractured or broken tooth.

Issue ages

18 to 89. One application can cover two people, and each of them picks their own plan and their own riders.

Underwriting

Simple underwriting. The application asks two health questions: whether you are currently living in a nursing home or assisted living facility or already receiving home health care or similar benefits, and whether you are physically unable to perform routine activities such as bathing, dressing, eating, toileting and transferring from bed to chair.

Renewability

Guaranteed renewable for life, with a 30 day free look to examine the policy and send it back. Premiums are based on your attained age, and the company may change the table of rates for everybody in the same class, with advance 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 the policy states that conditions named or described as excluded anywhere in it are never covered. The pre-existing limitation does not apply to the prescription drug benefit. Transcribed from the Nevada outline of coverage; the period may differ in another state.

Policy form

AS7008. Rider forms AM7008AB, AM7008AC, AM7008DD, AM7008DE, AM7008RE. Form numbers and benefits vary by state.

Every benefit below is transcribed from the Aetna Home Care Plus outline of coverage CLIHM03688NV (Nevada edition), for policy form CLIHCP16 NV, and from the Aetna Home Care Plus brochure CLIHM03744NV (Nevada edition), 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.

• Read this first: the home care benefit is weekly, and a week needs three visits Included

  It pays a weekly amount for each week the insured receives three or more medically necessary home care service visits, on separate days, of at least one hour per visit, in the insured’s home, from a home care practitioner. A week with two visits does not pay.

  Both other policies on this page pay a DAILY benefit. This one does not, and the three-visit test is the difference between a claim and no claim in a light week. Settle what your care plan actually looks like before choosing between these designs.

• How much the home care benefit pays, and for how long Included

  Weekly units of $150, up to a maximum weekly benefit amount of $1,500, with a choice of 13, 26, 39 or 52 covered weeks and a waiting period of 0 or 20 days. The lifetime maximum is equal to twice the number of covered weeks. At least one unit must be bought.

  The benefit begins after the waiting period and is limited by the maximum benefit amount, the maximum number of weeks per period of care and the lifetime maximum number of weeks selected.

• It also pays a daily hospital confinement benefit Included

  A daily amount for each day the insured is confined in a hospital, including observation stays, available in $10 units up to a maximum daily benefit amount of $400, with 20 days per period of care and a lifetime maximum of 365 days. At least one unit must be bought alongside the home care benefit — this part is not sold on its own.

  This is a hospital indemnity benefit inside a home care policy. It is the reason the policy form is headed a limited benefit hospital indemnity AND home care indemnity policy, and it is why this one is worth comparing against the hospital indemnity page as well as this one.

• Optional rider: a lump sum if you are diagnosed with cancer Optional rider

  $2,500, $5,000 or $10,000, paid once per lifetime on a diagnosis of cancer made after the effective date and after a 30 day benefit waiting period. Only one cancer benefit amount is paid per insured person under the policy, and the rider ends when the policy ends or when that benefit is paid.

  Waiting period: 30 days. The diagnosis must be pathological — a microscopic examination of fixed tissue, blood samples or preparations from the hemic system. A clinical diagnosis, based on the study of symptoms, is accepted only where a pathological one cannot be made and the medical evidence substantially documents it.

• Optional rider: emergency room visits and ambulance Optional rider

  $200 when the insured has an emergency room visit and/or an ambulance service by air, ground or water, available twice per calendar year with no lifetime maximum. Both must be medically necessary and provided on an emergency basis.

  Only one benefit per day is payable even if the insured has an emergency room visit and an ambulance service on the same day.

• What the policy does not pay for Not covered

  Outpatient treatment, services or supplies of any type. Confinement in a hospice care facility. A stay in a community living center or a place that primarily provides domiciliary, retirement or educational care. Confinement or care received outside of the United States. Mental or nervous disorders or substance use disorders. Pregnancy and related services, except complications of pregnancy. Cosmetic surgery, routine foot care, dental services, acne or varicose veins. Diagnostic lab testing, x-rays, advanced studies and venipuncture. Allergy testing and allergy injections. Experimental or investigational procedures or participation in clinical trials. Infertility and impregnation procedures. Obesity or weight reduction, including bariatric surgery and complications resulting from it. Tobacco cessation. Routine newborn care. Sex transformation, and treatment of sexual function, dysfunction or inadequacy. Therapy or treatment of learning disorders or disabilities, developmental delays or sleep disorders. Voluntary abortion, except where the insured’s life would be endangered if the fetus were carried to term or where medical complications have arisen from an abortion. Voluntary sterilization or its reversal.

  “Outpatient treatment, services or supplies of any type” is the broadest line in that list and the easiest to read past. This policy pays for weeks of home care and days in a hospital bed, and essentially nothing else.

• And what no benefit under the policy will pay for Not covered

  War, an act of war, a riot or international armed conflict. The commission or attempted commission of a crime or felony, an illegal act, or time imprisoned. Suicide or attempted suicide or intentionally self-inflicted injury, whether while sane or insane. Skydiving, scuba diving, hang or ultra light gliding, ballooning, bungee jumping, para-kiting, riding an all-terrain vehicle such as a dirt bike, snowmobile or go-cart, racing with a motorcycle, motor vehicle, boat or any form of aircraft, any participation in sports for pay or profit, or participation in rodeo contests. Services provided by a home health care agency which has any financial relationship with any member of your family or with your physician, other than an arrangement to provide you home health care.

  That last one matters here more than it would on most policies: a family-connected agency is exactly the arrangement people reach for when care is needed at home.

• Medicare is not excluded, but most other government services are Included

  Service rendered by any agency of the federal or state government, other than Medicaid, is excluded unless you are legally obligated to pay for it. The outline states in terms that Medicare is not excluded.

Issue ages

50 to 89, age at last birthday, on the base benefits and on both riders.

Renewability

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

Pre-existing conditions

A pre-existing condition is one the insured has been medically diagnosed with, treated by, sought advice from, or consulted with a physician about during the six months before the coverage effective date. Pre-existing conditions are not covered unless the loss begins more than six months after the coverage effective date.

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

CLIHCP16 NV. Form numbers and benefits vary by state.