The LTC claims experience: A benefit we should be selling

By Julie Gelbwaks Gewirtz

Gelbwaks Executive Marketing Corp.


As an industry, we have generally been focused on selling long term care insurance with heavy emphasis on creating the need, product design, carrier stability, pricing and underwriting. What seems to often get left out is the experience at claim time. Could it be that if more consumers knew and understood what the carriers make available to them during the claims process, more people would actually obtain this vitally important coverage?

Selling the LTCI claims experience as the benefit being purchased is a golden opportunity to get more of America insured. Here are five significant segments of the claims process offered by many of the major carriers that you and your prospects should absolutely be aware of.
    1. Advice and reports on providers that will best meet the needs of the claimant. When an individual needs assistance, it is typically a very emotional and stressful time for the family. It is important to get a qualified provider in the home, and as quickly as possible. At the same time though, it is just as important to research the available providers in the vicinity and make sure that they will best meet the needs of the claimant. Carriers generally offer assistance in this area. They will get detailed quality reports showing everything from ratings to consumer reviews, and give advice in that regard.

    2. Discounts on home care services, assisted living facilities and nursing homes. One of the biggest concerns at claim time is cost of care. We all know that when a policy is purchased, most people make an effort to buy a benefit amount that will be meaningful when they need it most. They do this by selecting a benefit that is similar to what the average cost for care is at the time, and then adding inflation riders depending on the age at purchase. But many times, when the claim occurs, there is not a sufficient amount of benefit available to cover the entire cost. A large number of carriers today make provider discounts available through networks that they have contracted with. This can be a very valuable advantage for most and helps to extend the length of the total benefit period on the policy.

    3. Assistance locating resources in the area where your client resides. Sometimes, the insured needs or wants assistance with things that are not covered by the policy. It could also be that they are just not eligible yet for a long term care insurance claim to be filed and approved. Many claims care coordinators will help the policyholder to find available area resources for free or at a very low cost. These can be things like meals on wheels, support from the local church or synagogue, etc. It is an excellent way to get help for the time being, or in some cases, through the elimination period wait time.

    4. Help implementing the plan of care. When the claim is initiated, a nurse will generally work with the claimant and his/her family to develop a comprehensive plan of care. They will discuss the care needs of the individual and help to determine what will be the best plan of action going forward. As previously stated, this is an extremely stressful time for the family and any assistance is typically greatly appreciated. A significant amount of studies have been done on consumer satisfaction with care coordination assistance showing that there is overwhelming acceptance around this benefit.

    5. Support as needs of the insured change. An overlooked feature in the LTCI claims world is how the carrier works with the claimant over time to follow the changing needs of that individual. Since every claims situation can be different, it is extremely important to make sure that each policyholder has the best possible experience. In order to do that, the carrier reviews the situation as it unfolds and helps to determine the appropriate follow-up intervals. The claim setting may need to change, as well as the care needs.
There are a variety of claims process brochures that have been developed by carriers in the marketplace today. Think about utilizing those during the sales process, as opposed to overemphasizing the product brochures. In addition, advise your clients that if and when they need care, they should call to initiate the claim as early as possible. It is much better to contact the insurance company too early than too late. That way, everything can be in place when the need is there.

When a consumer buys an LTCI policy, what they are really purchasing is a promise from that insurance company. A promise to make certain that his/her care needs will be met at the time of claim. They provide very important resources and assistance during what could be the most difficult time in a person's life. As an advisor, you should make sure to get that point across to your clientele. Owning a long term care insurance policy ensures for valuable support when your client needs it most.

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