PRUDENTIAL LONGTERM CARE INSURANCE E' L' Liz Barnes, LUTCF, CSA, CLTC

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PRUDENTIAL LONGTERM CARE INSURANCE E' L' Liz Barnes, LUTCF, CSA, CLTC

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Premiums resume following either the death or ineligibility of the eligible Spouse/Partner ... rated to the date of the ineligibility or death. CONSIDERATIONS ... – PowerPoint PPT presentation

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Title: PRUDENTIAL LONGTERM CARE INSURANCE E' L' Liz Barnes, LUTCF, CSA, CLTC


1
PRUDENTIAL LONG-TERM CARE INSURANCEE. L. Liz
Barnes, LUTCF, CSA, CLTC
T H E P R U D E N T I A
L I N S U R A N C E
C O M P A N Y O F A M
E R I C A
IFS-A110553 Ed. 12/06
For the education of Producers/Brokers only. Not
for use with the public.
2
LTC3SM, Prudentials third generation individual
long-term care insurance product, was designed to
bring customization of benefits to a new level.
Improvements have been made to the base plan
(available to all policyholders), additional
options have been added to the base plan
options and new plan enhancements (riders) are
available for an additional cost.
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BASE PLAN
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Facility Daily Benefit 50 - 500
MaximumIssue Ages 18-79
SERVICES COVERED- Nursing Home- Assisted
Living/Residential Care - Adult Foster Home/Board
Care Facility - Bed Reservation- Respite
Care- Hospice Care
In CA minimum FDB is 100 in NY minimum
FDB is 100 in metropolitan area and 70 in
non-metro area in WI minimum FDB is 60.
7
5
Respite Care (Base)
  • WHAT IS IT?
  • Recognizing that caregivers sometimes need a
    break, Respite Care provides 21 days (no Lifetime
    Maximum) annually to be used to purchase
    substitute care, providing relief of informal
    caregivers. This benefit is paid at the Facility
    Daily Benefit rate regardless of the site of
    care.
  • CONSIDERATIONS
  • Not Subject to Elimination Period.
  • Days do not count toward satisfying Elimination
    Period.
  • Reduces Lifetime Maximum.

In MA, days count toward satisfying the
Elimination Period.
8
6
Private Care Consultant (Base)
  • WHAT IS IT?
  • An annual pool equal to 20 X the Facility Daily
    Benefit to be used to retain services of a
    personal LTC advocate or expert (not associated
    with Prudential) to help the client and the
    clients family. A Private Care Consultant acts
    as the clients advocate, can help to arrange for
    the delivery of Long Term Care services, and can
    help choose providers.
  • CONSIDERATIONS
  • Not subject to Elimination Period.
  • Does not reduce Lifetime Maximum.
  • Can be used on a day when other benefits are
    needed.

9
7
Private Care Consultant (Base)
  • WHATS COVERED?
  • Among the services a Private Care Consultant
    might provide are
  • FAMILY COUNSELING- Helps the whole family cope
    with LTC issues
  • LONG DISTANCE CAREGIVING- Overseeing quality and
    quantity of care when caregiver cant be there
  • PLAN OF CARE- Developing a Plan of Care based on
    client/family/ personal needs/wishes

Not available to residents of TX
10
8
Bed Reservation (Base)
  • WHAT IS IT?
  • Pays LTC facility up to 60 days at Facility Daily
    Benefit per calendar year to reserve bed if
    client is away for any reason.
  • CONSIDERATIONS
  • Bed Reservation and Home Care will not be paid on
    same day.
  • Reduces Lifetime Maximum.
  • Subject to Elimination Period.

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9
WHAT IS IT?-Claimants will have the option of
electing this benefit on a monthly basis in lieu
of reimbursement for Eligible Charges for Home
Care. - Benefit is 40 of the Home Care
Daily Benefit amount. - Submission of bills or
proof of charges not required. - Need to
complete monthly Claim Form.- Subject to
Elimination Period and reduces Lifetime Maximum
by the actual monthly benefit amount
paid.CONSIDERATIONSCannot be used with Cash
Benefit Rider or Flexible Cash Benefit
Rider.TIP Allows for informal
caregivers/expenses that would otherwise not be
reimbursable.
Cash Alternative Benefit (Base)
In CA, benefit is 50.
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Home Support Services (Base)
WHAT IS IT? Lifetime pool equal to 50 X Facility
Daily Benefit to pay for support needs that
permit client to remain at home.
  • WHATS COVERED?
  • Assistive Devices Durable Medical
    Equipment
    (not covered by Medicare)
  • Home Modifications Emergency Response
    Systems
  • Caregiver Training
  • Transportation Services (for medically necessary
    health care subject to Plan of Care)
  • CONSIDERATIONS
  • May be used during Elimination Period.
  • Reduces Lifetime Maximum.
  • Can be used on a day that other benefits are
    needed.

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Alternate Plan of Care (Base)
  • WHAT IS IT?
  • Permits policy to cover services not specified in
    policy. Allows for future LTC services not yet
    known and the ability to provide non-standard
    services to current clients with special needs.
  • CONSIDERATIONS
  • Service
  • must be part of Plan of Care
  • meet Federal definition of qualified service
  • be approved client, Licensed Health Care
    Practitioner
  • and Prudential

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Benefit and Resource Information Service (Base)
  • WHAT IS IT?
  • Provided by Prudential without cost, Benefit and
    Resource Information services give guidance and
    assistance to clients and their families in
    understanding coverage, applying for benefits,
    submitting claims, and locating community
    resources.
  • CONSIDERATIONS
  • Does not reduce Lifetime Maximum.
  • Not subject to Elimination Period.

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Restoration of Benefits (Base)
  • ELIGIBILITY
  • If a previously eligible client is assessed and
    found to no longer have a Chronic Illness or
    Disability, and that status is maintained for 6
    consecutive months, Restoration of Benefits can
    restore the full Lifetime Maximum.
  • CONSIDERATION
  • A client can be 1 ADL deficient and still restore
    his benefits.
  • Benefits can only be restored once in a lifetime.

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Contingent Non-Forfeiture (BASE)
  • WHAT IS IT?
  • Provides a reduced Lifetime Maximum, or option of
    selecting policy with lesser benefits, if policy
    lapses due to Substantial Premium Increases.
    Definition of Substantial Premium Increase
    determined by state law and varies by clients
    age at purchase.
  • EXAMPLE If policy bought at age 40, substantial
    increase is 150 over the life of the policy. For
    a 75 year old purchaser, the figure is 30.

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International Coverage (Base)
  • WHAT IS IT?
  • Pays for out of country Nursing Home or Home
    Health Care, Homemaker Services or Personal Care
  • Paid at 75 (in NY and CA, 100) of the Facility
    Daily Benefit and Home Care Daily Benefit
  • HOW IT WORKS
  • Eligible Charges must be incurred outside US.
  • Subject to a Lifetime Benefit of 365 days.
  • Subject to Elimination Period and reduces
    Lifetime Maximum.
  • Must be certified by a U.S. Licensed Health Care
    Practitioner.
  • CONSIDERATIONS
  • Cannot be used with Cash Alternative or Flexible
    Cash Benefit Rider.
  • This benefit does not cover the following when
    provided or charges are incurred outside the
    U.S. Bed Reservation, Hospice Care, Respite
    Care, Home Support Services, Alternate Plan of
    Care or Private Care Consultant.

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Standard Waiver of Premiums (Base)
WHAT IS IT? After the Elimination Period is
satisfied, premiums will be waived on the day
following the date the Chronic Illness or
Disability is certified. Premiums will continue
to be waived as long as the insured is eligible
for benefits. CONSIDERATIONS Premiums will not
be waived if the insured is only receiving
Hospice Care, Respite Care, Home Support Services
or Information Services, all of which are not
subject to the Elimination Period. EXAMPLE
Elimination Period ends on 3/10. Premium is
waived as of 3/11.
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BASE PLAN OPTIONS
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Home Care Daily BenefitPERCENT OF FACILITY CARE
DAILY BENEFIT 50 75 100 150SERVICES
COVERED -Adult Day Care -Homemaker
Services -Personal Care -Home Health Care
Not available with Cash Benefit Rider or
Flexible Cash Rider .The 150 Home Care Daily
Benefit Option can only be selected with a
Facility Daily Benefit of 350 or less. In RI,
Home Care Daily Benefit cannot be less than 100.
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Daily Reimbursement for Eligible Charges up to
the Facility Daily BenefitMonthly Monthly
reimbursement pool for Eligible Charges up to
Home Care Daily Benefit x number of days in the
monthCash Benefit Rider (CBO) Monthly
indemnity payment equal to Home Care Daily
Benefit x number of days in the month
Submission of bills or proof of charges not
required Monthly submission of Claim Form
required. Flexible Cash Benefit Rider See next
slide for complete descriptionCONSIDERATIONS
Cash Benefit Rider not available with Unlimited
Lifetime Maximum, 150 Home Care benefit or Cash
Alternative feature in policy.
Home Care Payment Options
CBO is not available to residents of IN Plan
of Care is required.
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WHAT IS IT?Allows for 50 cash payment and 50
reimbursement of eligible charges every month.
Monthly Indemnity Payment is equal to 50 of the
Home Care Daily Benefit X Number of Days in the
Month. HOW IT WORKS- Monthly Submission of
Claim Form is required for 50 Cash Benefit.-
Submission of bills is required for 50
reimbursement.CONSIDERATIONS- Cannot be used
with CBO, Cash Alternative, Unlimited Lifetime
Maximum, 150 Home Care.- Cannot be used for
services received outside the US.
Flexible Cash Benefit Rider
Not available to residents of CA or IN.
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Lifetime Maximum
2 yrs., 3 yrs., 4 yrs., 5 yrs., 6 yrs., 10
yrs., and Unlimited Ages 18-79
Not available to residents of FL.
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Elimination/Benefit Waiting Period
  • 30, 60, 90, 120, 180, 365 Calendar Days
  • Ages 18-79

Variations CT no 120, 180, or 365FL no
365GA no 90, 120, 180, or 365KS no 180 or
365NY no 365PA no 180 or 365SD no 120,
180, or 365VT no 120, 180, or 365
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Calendar Day Elimination Period
  • HOW IT WORKS
  • The Elimination Period is counted in Calendar
    Days.
  • Eligibility date is date Chronic Illness or
    Disability is certified by a Licensed Health Care
    Practitioner.
  • No need for services or incurred costs to satisfy
    the Elimination Period.
  • Elimination Period does not have be satisfied to
    use the following
  • Home Support Services
  • Private Care Consultant Benefit
  • Hospice Care
  • Respite Care
  • Elimination Period days
  • are cumulative
  • must be met only once per lifetime

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Inflation Protection Options
  • NONE
  • Guaranteed Purchase Option
  • Automatic 5 Simple Inflation Benefit
  • Automatic 5 Compound Inflation Benefit - 2X
    Maximum
  • Automatic 5 Compound Inflation Benefit- No
    Maximum

Variations CT no Automatic 5 Compound
Inflation Benefit - 2X Maximum IN no Automatic
5 Simple Inflation Benefit or Automatic 5
Compound Inflation Benefit - 2X Maximum WI no
Automatic 5 Simple Inflation Benefit
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Guaranteed Purchase Option (GPO)
  • WHAT IS IT?
  • Increases will occur automatically every 3 years
    unless the offer is refused in writing (negative
    election).
  • Benefits will increase by 5 of the current
    policy benefit amount, compounded annually over
    the 3 year period only catch-up no longer
    offered.
  • No evidence of insurability is required.
  • Increased coverage is rated at insureds attained
    age.
  • Increases will be made even if Insured is benefit
    eligible or on claim.
  • Offers continue as long as policy in-force even
    if premium waived.
  • CONSIDERATIONS
  • Cannot be purchased with 10 Pay or Paid Up At Age
    65, Premium Reduction at Age 65, Joint or
    Survivor Waiver of Premiums, or Shared Care.

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-Benefits increase annually by 5 of the Original
Policy Benefits as long as the Policy is in
force.-The increase amount is the same each
year and your benefits double in 20 years.
Automatic Simple Inflation Option
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Automatic Compound Inflation Options
  • AUTOMATIC 5 COMPOUND-2X MAXIMUM Benefits
    compound at 5 annually until Facility Daily
    Benefit is twice original elected amount
    (approximately 14.5 years).
  • AUTOMATIC 5 COMPOUND-NO MAXIMUM Benefits
    compound at 5 annually as long as policy is
    in-force
  • CONSIDERATION
  • Automatic Compound No Maximum Option cannot be
    changed to Automatic Compound 2x Maximum after
    Facility Daily Benefit reaches 2x original
    Facility Daily Benefit

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Discounts
  • Spouse/Partner Discount
  • 15 discount for one Spouse/Partner, when the
    other Spouse/Partner is not covered by a
    Prudential Individual Long Term Care Policy.
  • 30 discount for each Spouse/Partner when both
    are covered by a Prudential Individual Long Term
    Care Policy.
  • Multi-Life (Employer Sponsored Program) Discount
  • ESP 10 discount for Employees with Modified
    Underwriting.
  • 10 discount for Spouse/Partner with full
    Underwriting.
  • 5 discount for family members with full
    underwriting.
  • Offset by commission contribution.
  • Affiliation Discount
  • 5 for members and others in case offset by
    commission contribution

Varies in NJ, not available in all states. In
NY, Spouse discounts are 10 and 25.
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Plan Enhancement (Riders)
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SHORTENED BENEFIT PERIOD (Rider)
  • WHAT IS IT?
  • If policy is in-force 3 years, client may lapse
    policy for any reason and retain coverage equal
    to 30X policys current Facility Daily Benefit or
    total premiums paid less any benefits paid,
    whichever is greater.

Varies by state
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Joint Waiver of Premiums (Rider)
  • WHAT IS IT?
  • If both insured and Spouse/Partner have a
    Prudential individual LTC insurance policy and
    one qualifies for Waiver of Premium, the others
    premium will be waived as well. Premiums will
    resume on the first day after the chronic illness
    or disability ends.
  • If one Spouse/Partners policy lapses without
    using benefits under this option, the option
    shall be voided and the premium adjusted for the
    remaining Spouse/Partner. This option must be
    purchased at the time of, or within six months
    of, the original issue date.
  • HOW IT WORKS
  • Premiums resume following either the death or
    ineligibility of the eligible Spouse/Partner
  • Premiums will be pro-rated to the date of the
    ineligibility or death
  • CONSIDERATIONS
  • Not available with GPO or Shared Care rider

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Survivor Waiver of Premiums Benefit (Rider)
  • WHAT IS IT?
  • This option is only available if both
    Spouses/Partners have purchased a Prudential
    individual LTC insurance policy. With this
    benefit, if after 10 years of paying premiums
    and, if no claims were made against either
    policy, one party dies, the survivor's premium
    will be permanently waived.
  • HOW IT WORKS
  • Premiums permanently waived if one Spouse/Partner
    dies and
  • Both policies and the rider have been paid for 10
    years
  • No claims have been made by either Spouse/Partner
    for the first 10 years.
  • If a Spouse/Partner dies or lapses prior to
    activating benefits under this option, the option
    shall be dropped for the remaining Spouse/Partner
  • CONSIDERATIONS
  • Not available with 10 Year Paid Up Option, GPO
    Rider or Shared Care Rider. Not available to
    residents of WA.

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SHARED CARE BENEFIT (Rider)
  • COVERED BENEFITS
  • Shared Care Benefit
  • If one Shared Care Partner exhausts benefits
    under his own policy, he can access benefits
    under the other Shared Care Partners policy.
    May exhaust all the benefits.
  • Survivor Benefit
  • If one Shared Care Partner dies before exhausting
    his own Lifetime Maximum, the remaining Lifetime
    Maximum is available to the surviving Shared Care
    Partner when he exhausts his own limits.
  • Exhaustion of Benefits
  • If one Shared Care Partners Lifetime Maximum is
    exhausted by the other Shared Care Partner, he
    can purchase a new policy at attained age with a
    two year Lifetime Maximum on a Guaranteed Issue
    basis if age 90 or younger.

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SHARED CARE BENEFIT (cont.)
  • CONSIDERATIONS
  • Both Shared Care Partners have the rider and
    designate each other as the Shared Care Partner
  • Both Shared Care Partners have and maintain
    identical Policy Benefits, including Optional
    riders.
  • Both Shared Care Partners have the same Premium
    Payment Option.
  • Cannot be combined with GPO, Unlimited Lifetime
    Maximum, Return of Premium at Death, Joint and
    Survivor Waiver of Premiums.

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Return of Premium Upon Death (Rider)
  • WHAT IS IT?
  • At death, premiums paid for policy and riders
    will be returned to the estate.
  • Refund equals total amount of premiums paid
    minus any benefits Prudential had paid or are
    payable.
  • HOW DOES IT WORK?
  • Benefit will be paid even if Insured was
    receiving benefits and premium was waived.
  • Refund does not include waived premiums.
  • CONSIDERATIONS
  • Cannot be used with Shared Care rider. Not
    available to residents of NY or PA.

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Premium Payment Options
  • Lifetime Premiums are paid until waived or
    policy ends or lapses.
  • PREMIUM REDUCTION AT AGE 65 Premiums reduced by
    50 at age 65
  • Available to ages 60 or younger
  • Premiums are paid throughout a lifetime
  • ALTERNATIVE PAYMENT OPTIONS
  • 10 YEAR PAID UP Premiums paid for 10 years.
  • - Available to ages 40 - 75
  • PAID UP AT AGE 65 Premiums paid until age 65.
  • - Available to ages 54 and under.

Variations NJ and TN if purchase alternative
payment option must also purchase Non-forfeiture
- Shortened Benefit Period Rider FL Lifetime
only PA Lifetime and Premium Reduction at 65 TX
Lifetime only
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Definition of Partner A person of the same or
opposite sex who meets all the criteria listed
below
  • is over age 18
  • have lived together at least 12 consecutive
    months preceding the date of Application
  • have a serious and committed relationship
  • is not legally married, nor a Partner to anyone
    else and
  • is financially interdependent. Financially
    interdependent means that the Partners must
    share the cost of food and housing. While they do
    not have to contribute equally or jointly for
    each of these expenses, each must be responsible
    for such costs.
  • Examples of situations that might involve
    Partners would include households composed of
    siblings, parent/ child, other familial
    relationships, domestic partners, or any two
    individuals of either or both sexes who have
    established a stable, committed association with
    the clear and expressed expectation of long term
    cohabitation.

Definition varies by state.
This discount is not available in some states.
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Rating Classes
  • Preferred .85
  • Standard I 1.00
  • Standard II 1.25

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Multi-Life
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Multi-Life
  • Multi-life Opportunity
  • The multi-life LTC market is one of the fastest
    growing components of LTCi sales
  • Executive Carve Outs
  • Employee Benefits
  • Opens door for cross-selling approach
  • Prudential offers LTCi products to
  • Individuals (small employer groups)
  • Associations
  • Large corporations

41
Impact of Caregiving on Employers
  • The National Alliance for Caregiving and AARP
    Survey1 found
  • 1 out of 4 U.S. households are involved in
    caregiving
  • 2 out of 3 caregivers are employed fulltime
  • 1 out of 3 caregivers lose up to 16 hours of work
    per month due to caregiver responsibilities
  • 11Caregiving in the U.S. National Alliance for
    Caregiving (NAC) and AARP. May, 2005.

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Impact on Employer Employee
  • Result of care-giving
  • Businesses lose up to 33 billion annually1
  • Absenteeism
  • Decline in productivity
  • Interruptions (emergencies and calls)
  • Decreased morale and motivation
  • Unwillingness to travel inability to relocate
  • Employees are physically, emotionally,
    financially drained
  • 30 of employees with parent age 65 miss work2
  • 31 quit work3
  • 67 adjust work schedules4
  • Impacts retirement educational saving
  • 2/3The State of Aging and Health in America 2004.
    1 National Alliance for Caregiving

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Financial Costs of Informal Caregiving
  • 1 out of 2 caregivers provide more than 8 hours
    of caregiving per week.1
  • 17 provide more than 40 hours per week.1
  • Estimated loss to informal caregiver
  • 25,494 in social security benefits
  • 67,202 in pension benefits
  • 566,433 in wages
  • Total lifetime loss 659,1392
  • Source The State of Aging and Health in America
    2004. http//www.caregiver.org/factsheets/selected
    _caregiver_statistics.html

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Employer Sponsored Program (ESP) Highlights
  • Employer group size requirement
  • NEW 3-9 Life Market (All eligible employees must
    be insured) Employer may Class Out the group
  • 10 to 500 lives (must work minimum of 30 hours
    per week)
  • Minimum participation requirement
  • Under 10 lives, 100 of the Class, otherwise
    groups of 10-500, the greater of 10 Individuals
    or 5 of the group, Spouses included for minimum
    participation.
  • Discounts
  • 10 discount to employees spouse/partner
  • 5 discount to family members
  • No maximum on discounts
  • Preferred health rate class not available to
    employees under ESP
  • Modified underwriting (employees ages 18 - 70)
  • Customized plan design for every client
  • Buy-ups available
  • Parents, in-laws, aunts, uncles, siblings,
    grandparents, grandparents in-law, and children
    ages 18 and older.

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ESP Plan Design
  • Options with modified underwriting
  • 50 - 300 Facility daily, monthly, or cash
    benefit
  • 50, 75 or 100 home care
  • Benefit periods 2, 3, 4, 5, or 6 years
  • Elimination period 60, 90, 120, 180, or 365 days
  • All Inflation options available
  • Accelerated premium options available
  • 10 pay
  • Paid-up at 65
  • Buy-ups available
  • Lifetime,higher daily,monthly or cash benefits,
    etc.

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Optional Riders
  • With modified underwriting
  • Flexible cash benefit rider
  • Cash benefit rider
  • Return of premium upon death benefit
  • Available as buy-up with full underwriting
  • Shared care benefit
  • 150 home care daily benefit
  • Joint waiver of premiums benefit
  • Survivor waiver of premiums benefit
  • For the Prudential LTC3 product only. Contact
    your Regional Sales Manager with questions on LTC
    By DesignSM.

47
ESP Modified Underwriting Questions
48
  • Do you use walker, oxygen, respirator, or kidney
    dialysis?
  • Within past 12 months have you used adult day
    care, needed home health care, or been medically
    advised to enter or been confined to nursing
    home, assisted living facility, or other LTC
    facility?
  • Do you currently need assistance or supervision
    by another person in performing any of the
    following activities bathing, eating, toileting,
    bowel or bladder control, moving in and out of
    bed or chair, dressing, or taking your
    medication?
  • Have you had, do you currently have, or have you
    ever been diagnosed as having any of the
    following medical conditions
  • Organic Brain Syndrome, Dementia, Senility,
    Confusion, Memory Loss, or Alzheimers Disease?
  • Metastatic Cancer (cancer that has spread from
    original site or location?)
  • Multiple Sclerosis (MS), Muscular Dystrophy,
    Multiple Transient Ischemic Attacks (TIA),
    Parkinsons Disease, Amyotrophic Lateral
    Sclerosis, Stroke, or Cerebrovascular Accident
    (CVA)?

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Exclusions
  • 1.Illness, treatment or medical conditions
    arising out of
  • a)War or an act of war
  • b)Participation in a Felony, riot or
    insurrection, or
  • c) Alcoholism and drug addiction
  • 2. Treatment provided in a government facility
  • 3. Charges for services or supplies normally
    provided without
  • charge.
  • 4.Charges for care or treatment provided outside
    the United
  • States except as described in the
    International Coverage benefit.
  • 5. Charges for expenses reimbursable under
    Medicare or for expenses that would be
    reimbursable under Medicare but for the
    application of a deductible or coinsurance
    amount.
  • 6. Benefits under your policy may be reduced if
    Prudential also pays benefits for Eligible
    Charges under any other Prudential Individual
    Long Term Care Insurance Policy.

No exclusions apply to the Cash Benefit rider,
the cash portion of the Flexible Cash Benefit
rider or the Cash Alternative benefit. Vary by
state
Summary is for descriptive purposes only. All
provisions are subject to the language of the
actual policy, including the definitions, terms,
conditions and exclusions set forth in the policy.
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Initiating A Request for an ESP Case
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(No Transcript)
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Disclaimers
LTC3SM long term care insurance is underwritten
by The Prudential Insurance Company of America,
751 Broad Street, Newark, NJ 07102
(800-732-0416). The Prudential Insurance Company
of America is authorized to transact business in
all U.S. states and the District of Columbia. All
insurance policies/options may not be available
in your state. Coverage is issued under policy
number GRP 113096 however policy numbers may
vary by state. The Prudential Insurance Company
of America is a Prudential Financial company.
Prudential Financial is a service mark of The
Prudential Insurance Company of America, Newark,
NJ, USA and its affiliates.
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