Why long-term care insurance, levels of care, and where care happens
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Medicare and Medigap do not pay for custodial care; Medi-Cal pays only if you meet its financial rules.
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Home care policy: 6 required benefits — home health, adult day care, personal care, homemaker, hospice, respite.
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Residential care facility benefit ≥ 70% of the nursing facility benefit.
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No skilled-nursing-only LTC policies in California.
Benefit triggers, forms of LTC coverage, and renewability
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Trigger: 2 of 7 ADLs (non-qualified) OR cognitive impairment; no prior hospital stay required.
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Federally qualified: 6 ADLs (no ambulating), no cash value, certification renewed every 12 months.
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Offer qualified → must also offer non-qualified at the same time.
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Guaranteed renewable: rates change only by class, never for one person.
Selling LTC: training, HICAP, honesty and cold leads
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8 hours of LTC training before soliciting; then 8 hours in each of the first 4 years, and 8 before each renewal.
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Shoppers guide: before the application is presented. HICAP notice: at solicitation.
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Cold lead contact → disclose it immediately.
Suitability, the Personal Worksheet, and replacement
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Suitability = ability to pay + goals/needs + existing vs. proposed coverage. Never the agent's commission.
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Personal Worksheet must come back before the issuer considers the applicant.
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3rd LTC policy to the same person within 12 months = presumed unnecessary.
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Replacement commission: first-year rate only on the premium increase.