Property Damage

Property Damage Liability is required by NYS law. This coverage pays for damage you (or someone driving the car with your permission) may cause to someone else's property. Usually, this means damage to other cars in the accident, but it also includes damage to lamp posts, telephone poles, fences, buildings or other structures your car may hit.
 

HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires that all LTC policies must contain certain provisions for their benefits to qualify for tax-exempt treatment. These provisions include the definition of the types of services offered by the plan, and the definition of when an individual becomes eligible for benefits under the plan. Both provisions must conform to qualifying standards under HIPAA. In addition, LTC policies also must adopt certain provisions of the National Association of Insurance Commissioners (NAIC) LTC insurance model regulation.

 
Personal Injury Protection

Personal Injury Protection (PIP) coverage, commonly known as
No-Fault coverage, is required under NYS law. Under this coverage, your insurer pays you and relatives living with you for economic losses arising from injuries sustained in motor vehicle accidents anywhere within the United States, its territories and possessions, or Canada.

This coverage includes the following benefits (applicable limits are established by NYS and may be adjusted periodically):

Medical Expenses – reasonable and necessary expenses incurred for
the care, recovery or rehabilitation of the injured person.
Work Loss – wages you would have earned if you had not been
hurt (subject to maximum monthly amount and time period).
Other Expenses – expenses for services you are no longer able to provide for yourself or your family because you are injured, such as housekeeping or yard work (subject to maximum daily amount and
time period).
Death Benefits – up to a specific limit per person. It is wise to consider higher limits over the basic requirement for No-Fault protection since it
is relatively inexpensive, and it increases your level of protection in a very cost effective manner.
 

designed to provide a benefit for elderly individuals who live in a continuing care retirement community. Retirement communities are geared to meet senior citizens’ full-time needs, both medical and social, and often are sponsored by religious or nonprofit organizations.  It provides independent and congregate living and personal, intermediate, and skilled nursing care, and attempts to create an environment that allows each resident to participate in the community’s life to whatever degree desired.
 

designed to provide a short rest period for a family caregiver… there are two options: either the insured is moved to a full-time care facility or a substitute care provider moves into the insured’s home for a temporary period, giving the family member a rest from care-giving activities.
 

designated for those who require assistance with various activities of daily living, while their primary caregivers (usually family or friends) are absent. These day care centers offer skilled medical care in conjunction with social and personal services, but custodial care usually is their primary focus.
 

provided in the insured’s home, usually on a part-time basis… can include skilled care (such as nursing, rehabilitative, or physical therapy care ordered by a doctor) or unskilled care (such as help with cooking or cleaning)
 

provides assistance in meeting daily living requirements, such as bathing, dressing, getting out of bed, toileting, etc. Such care does not require specialized medical training, but it must be given under a doctor’s order... usually is provided by nursing homes but also can be given by adult day care centers, by respite centers, or at home.
 

provided by registered nurses, licensed practical nurses, and nurse’s aides under the direct supervision of a physician… provided in nursing homes for stable medical conditions that require daily, but not 24-hour, supervision.
 

continuous around the clock care provided by licensed medical professionals under the direct supervision of a physician… usually administered in nursing homes.
 
Towing and Labor Costs

This coverage will reimburse you up to the limit you select for your necessary towing charges should your insured car become disabled.  If you are covered by a “road-side assistance” service through another program, you may not need to add this coverage to your auto policy.
 

Chronically Ill

As a result of HIPAA, an individual must be diagnosed as chronically ill; prior hospitalization can no longer be used as a benefit trigger. Diagnosis of chronic illness can be made on two levels: physical and/or cognitive. The physical diagnosis of a chronically ill individual is one who has been certified as being unable to perform at least two activities of daily living. An LTC policy must take into account at least 5 of these ADLs. In addition, an individual would be considered chronically ill if she/he requires substantial supervision to protect her/his health or safety owing to severe cognitive impairment and this condition was certified within the previous 12 months.
 

LTC (long term care) refers to a broad range of medical, personal, and environmental services designed to assist individuals who have lost their ability to remain completely independent in the community. Although care may be provided for short periods of time while a patient is recuperating from an accident or illness, LTC refers to care provided for an extended period of time, normally more than 90 days.  And, depending on the severity of the impairment, assistance may be given at home, at an adult care center or in a nursing home.
 

LTC Insurance Contracts

To be treated this way, the LTC policy must be qualified. This means that the policy’s provisions must conform to certain standards and guidelines as set forth by the IRS and HIPAA (the Health Insurance Portability and Accountability Act of 1996). Among the qualifying standards is the requirement to conform to the National Association of Insurance Commissioners (NAIC) long-term care insurance model regulations.

In brief, the NAIC model addresses such things as:
• Policy renewability (policy must be guaranteed renewable)
• Prohibitions on limits and exclusions
• Policy replacement
• Policy conversion
• Prohibitions against post-claims underwriting
• The requirement to offer inflation-adjusted benefits
• Proper marketing standards
• Suitability and appropriateness of the recommended purchase
• A standard format for the outline of coverage

 
 
Activities of Daily Living

Eating, toileting, transferring, bathing, continence, and dressing.  ADLs provide an excellent means to assess an individual’s need for nursing home care, home health care, or other health-related services. A policy should indicate what number and type of ADLs will be used to trigger benefits. When the insured cannot perform these ADLs independently, benefits will be paid to cover expenses for assistance with those activities.
 


Long Term Care Insurance Get Quote Now

Americans are living longer and many can expect to live a substantial portion of their lives in retirement.  That’s good news. The bad news is, although statistics regarding the longevity for older Americans may be improving, many individuals over age 65 still have to deal with poor health during their retirement years.

Medicare and Medicare Supplemental Insurances provide protection against the costs or medical care, however, neither of these programs covers long-term custodial or nursing home care. The cost of extended day-in/day-out care can be staggering, up to $50,000 or more each year for nursing home care, and upwards of $1000 or more a month for aides who come to one’s home. How can these costs be paid?  The solution is a Long Term Care (LTC) Insurance Policy.

LTC insurance contracts are treated in the same manner as accident and health insurance contracts, and are similar to most insurance plans, in that the insured, in exchange for a certain premium, receives specified benefits as defined by the policy. Most LTC policies pay the insured a fixed dollar amount for each day that covered services are received regardless of what the care costs.

Typically, the need for LTC arises when physical or mental conditions, whether acute or chronic, impair a person’s ability to perform the basic activities of daily living.

Qualified services are defined as the necessary diagnostic, preventive, therapeutic, curing, treating, mitigating, and rehabilitative services, and the maintenance or personal care services that are required by a chronically ill individual and are provided under a plan of care set forth by a licensed health care provider.  The kinds of services and support associated with long-term care are provided at three levels: institutional care, home-based care, and community care. These broad levels include many types of care, any or all of which may be covered.
Skilled nursing care...
Immediate Nursing care...
Custodial care...
Home health care...
Adult day care...
Respite care...
Continuing care...

Qualifying for Benefits - The benefit trigger is an event or condition that must occur before policy benefits become payable.

Benefit Limits - usually set in terms of a dollar limit or how long the benefits are paid for any one covered care service or combination of services. A policy may also include separate maximum coverage periods for nursing home care and home health care.

Age Limits - LTC policies typically set age limits for issue, and many policies also set a minimum purchase age.

Renewability - As a result of the 1996 HIPAA, all LTC policies sold today must be guaranteed renewable. This means the insurance company cannot cancel the policy and must renew coverage each year, as long as premiums are paid. The insurer may raise premiums only for entire classes of insureds.

Probationary Periods - can range from 0 to 365 days. The longer the deductible or probationary period, the lower the premiums.

Specified Exclusions - usually drug and alcohol dependency, acts of war, self-inflicted injuries, and non-organic mental conditions. Organic cognitive disorders, (Alzheimer’s disease, senile dementia, Parkinson’s disease) are almost always covered.

Premium - based on a number of factors: insured’s age and health, type and level of benefits provided, inclusion or absence of a deductible or probationary period, inclusion of options or riders.

2022 Western Avenue • Albany NY 12203 • Office hours: Monday - Friday 9:00am - 5:00pm
Phone: 518.452.2736 • Fax: 518.452.2851 • Email: insurance@bradleyagency.com


Guilderland Chamber of Commerce Albany Colonie Regional Chamber of Commerce PIA New York CPCU Society of Northeastern New York Community Caregivers





As a result of HIPAA, amounts received under a qualified long-term care contract are excluded from income because they are considered amounts received for personal injuries and sickness. However, there are daily and yearly limits on these amounts which are adjusted periodically for inflation.  In other words, benefits payable under long-term care policies are not taxable at all to the extent that they cover incurred costs. If an LTC policy pays a benefit that exceeds actual costs, the excess above the daily or yearly limit is taxable to the insured.

 

Website design, and maintenance by: SchoolhouseGraphics.com