GLOSSARY OF TERMS
Activities of Daily Living (ADLs)
Activities that people do independently every day: eating, toileting, transferring, bathing, dressing, and maintaining continence.
A medically unstable condition requiring frequent monitoring of an individual by medical professionals, such as physicians and registered nurses.
Adult Day Services
Adult Day Services help adults remain living in their own homes for as long as possible. Through structured activities and services, Adult Day Services provide regular care and supervision outside of the home for part of a day.
Assisted living is a residential alternative promoting maximum independence for each resident through a combination of supportive services and assistance.
Case Management can help identify resources before a crisis occurs and can also help an individual locate the most appropriate resources and services which can best meet their needs.
Community Based Services
Services provided that may prevent or delay the need for care in a long-term care facility, such as a nursing home or assisted living facility. Examples of community-based services may include: adult day services, respite care, homemaker services, personal care or home care services.
Copayment or Coinsurance
The amount you must pay for each medical service, outpatient hospital service or hospital stay.
Non-medical care that helps individuals with Activities of Daily Living.
Daily Benefit Amount
The amount your insurance policy will cover for each day services are provided. Some policies pay a flat daily benefit amount, while others will pay reasonable and customary charges up to the daily benefit amount.
The amount you must pay for health care before Medicare or private medical insurance begins to pay.
Dollar for Dollar Asset Protection
South Dakota Medicaid allows a person with a Partnership policy to protect the value of assets equal to the amount of benefits paid by the Partnership policy.
The number of days of out-of-pocket expense paid by the insured for long-term care services after the insurance benefits are triggered. Sometimes this period is defined as the waiting period. Policies are available with shorter elimination periods at higher premium cost.
Individuals with existing long-term care policies may be able to exchange their current policies for Long-Term Care Partnership policies through a rider, endorsement, or change in schedule page as long as the policy meets the core requirements for a Partnership policy.
Note: While the South Dakota Long-Term Care Partnership Program allows for the exchange of policies, it is up to each insurer if they want to offer exchanges.
The need for assistance to carry out a specific number of Activities of Daily Living.
An individual policy can be continued in force by the insured through the timely payment of premiums, and the insurer has no unilateral right to make any change in any provision of the individual policy while the insurance is in force except that premium rates may be revised by the insurer on a class basis. The insurer cannot decline to renew the individual policy as long as the insured makes timely payment of premiums.
These services provide individuals with assistance in completing tasks they are unable to do alone. These tasks may include general household activities, such as meal preparation and housekeeping.
Inflation Protection Benefit
Increases the daily benefit amount and policy maximums over time to help keep pace with inflation and increased expenses.
A policy that has been cancelled due to the non-payment of premiums. Applicants and policyholders should take advantage of the option to designate someone to receive lapse notices. This provides you with an extra layer of protection should you accidentally miss a premium payment. Having someone designated to receive a notice will help prevent any unwanted cancellation of coverage.
A policy sold on the basis that the premium will remain the same throughout the life of the policy. An insurer may seek a premium increase for all policyholders in an insured class, and such an increase will apply to all policyholders within the class if granted.
Long-term care includes a wide range of services provided to people who need continued help with Activities of Daily Living, such as: bathing, dressing, eating, using the toilet, continence, transferring from a bed to a chair.
Long-term care can be provided in a variety of places, including a person's home, an assisted living facility or a nursing home.
Long-Term Care Insurance
Insurance available through private insurance companies as a means for individuals to pay for needed care and protect themselves against the high costs of long-term care.
Long-Term Care Partnership Program
The South Dakota Long-Term Care Partnership Program, administered by the Department of Social Services and Division of Insurance, provides an alternative to spending down or transferring assets by forming a partnership between Medicaid and private long-term care insurers.
Maximum Policy Benefit or Maximum Lifetime Benefit
The period of time or dollar amount limit for which long-term care benefits will be paid under the policy.
Medicaid (Title XIX)
Medicaid and Title XIX are the same program. It is a program administered by the State of South Dakota to provide health care for low income individuals, families and children. In addition, individuals must meet certain eligibility and income criteria before they receive benefits from Medicaid.
A federal health insurance program to assist those 65 and older and individuals under age 65 with certain disabilities. Medicare covers only skilled care in a skilled nursing home and limited skilled care at home. It does not usually provide benefits for personal or custodial care, and for this reason provides limited assistance in long-term care. Medicare requires co-payments and deductibles.
Nursing homes provide care to people who cannot be cared for at home or in the community. For people who are unable to care for themselves due to physical, emotional, or mental health issues, nursing homes can provide a wide range of personal care and health services.
Period of Care
A specified number of days of care either in a nursing home or while receiving home care services without a break in the services.
Personal care services provide essential tasks necessary for individuals to remain living in the community. These services are provided if there is a medical-related condition and services are provided in the client's residence and workplace.
A condition for which medical advice was given or treatment was recommended by, or received from, a licensed health care provider within six months before the effective date of coverage. If the insurer uses a pre-existing condition limitation, then the pre-existing condition limitation cannot be excluded from coverage for more that six months after the effective date of coverage.
Respite care provides temporary relief to the primary caregiver from the continuous support and care of an elderly or dependent adult.
Please refer to the Administrative Rules on long-term care insurance for a more detailed listing of terms and definitions.