I have a John Hancock LTC policy. The policy has a 90 day “qualification period” after my wife has been determined eligible. Any advice?

Thanks to everyone who offered advice. When I called JH to find out status of claim I was told they had not received the evaluation from the JH nurse and when they did receive it they had 13 days to make a determination. I know that they had already received the evaluation. This is when I started complaining about length of time to determine if she was eligible. I was well aware of the 90 day “qualification” period. According to my policy this period did not start until she was determined eligible, which was why I was complaining. I’ll jump to the end here....I don’t know if insurance commissioner threat had anything to do with it, but when I called 2 days later she was approved and benefits starting 2 weeks later. I know Hancock got out of the LTC Business awhile back. The way I understand it those policies had built in inflation features with no increase in premiums. My policy has a set daily amount 81 for home healthcare 111 for assisted living 133 for nursing. Fortunately I can cover the difference. If there is any take away from all this I would recommend you call and document. Several times I called to find the process in Limbo and needed a push. One more thing, it’s important to note the qualification period is not a $ deductible but a time deductible. You can for example use home health care one day a week during the qualification period and then receive 7 day benefits after the time period

We have LTC insurance that also has a 90 day period. However, they were able to count the 90 days my husband was receiving Medicare in home services (due to an intially acute condition) as satisfying the 90 day waiting period. The insurance company requested the records from the home health agency providing the services, along with records from all my husband's doctors. We were told that the records, plus a long information form we filled out, were enough for certification and they didn't need to send anyone to the house. Husband is getting in-home services through the LTC policy, just a few days a week so far. After the first year, the company did send someone to our home to recertify the need for services. There was only about a month gap between the time the Medicare services ended and the LTC insurance was approved. You may want to check if the 3 weeks in the skilled nursing place can be counted toward the 90 days.

Couple of things......Policy terms are what’s going to matter as it’s a contract. The 90 day qualifying (or elimination) period is pretty standard & the premium you’ve been paying has been lower cause it has a 90 day delay to pay period. Some are 120 days... horrors!! LTC policies have a built in “gap” in coverage due to this which tends to be overlooked. Add to this that Hancock, like Met life, have exited the LTC insurance biz in that no new policies written now for quite a while so the staffing to deal with servicing the old LTC has shrunk or outsourced. There’s no Hancock agents to help you file as polices not written anymore. So it’s beyond lackluster as you’ve experienced.

Complaining to insurance commissioner before qualifying period is done is, imho, a waste of energy as it’s not in payout phase yet as per policy terms. The policy not activated yet. We went thru Katrina & Deepwater Horizon claims & imo insurance commissioner really can’t do much for individual situations other than write you a letter of we’ll look into it. It’s got to be a huge # of policyholders that are filing to get any traction. & even then the paperwork is daunting.

You might want to think of the qualifying as a deductible that has to be paid BEFORE the policy will activate. It will be a hefty deductible as it means private paying for basically 3 months in a NH as that’s the qualifying period if it’s that type of LTC policy or 3 months of home health if it’s that type. And the count down usually starts day 1 from when they are no longer hospitalized & no longer considered a rehab patient in the facility, as those periods are covered in some way by Medicare and other insurance (usually LTC insurance wont pay if another insurance will).. So if she transition from being a rehab patient to a NH LTC resident on Sept 1 then her first day LTC policy activation Nov 29. If you applied “prior to her release” before she transitioned, it’s going to be denied from the get go as she’s was not in a LTC yet and it can’t be an active file. Which is going to make things even more confusing all around. Most LTC have a preauthorization schedule for filing, like 15 days before she hits her 90 day mark, is when you can file. And then they send the paperwork that the facility has to do IF it’s that coverage or to home health agency IF it’s that coverage. You can’t speed up the process, it’s whatever’s in the terms of the policy that is the playbook.

Do you know what the DBA (daily benefit amount) is for her policy? How much of a “gap” or shortfall to cover her daily rate? Do you have an inflation rider or index on the policy? Sometimes families find that having them go onto LTC NH Medicaid is better financially. If that could be a possibility, please get with a NAELA or CELA level of elder law attorney as the situation for NH spouse & community spouse is not simple.

I'm confused. Did the 90 day qualification period start in early August, when she was in skilled nursing, or does it start after the next 13 days, i.e. you then have 90 more days before it kicks in? I seems to me that after the next 13 days you're about at the 90 waiting period, counting from early August. I don't have any insight to give to you but I, too, have a John Hancock LTC policy and I'm trying to figure out how it would work.

I had to file a claim for my dad's LTC insurance. There was a 90-day elimination period so we had to pay for the first three months. The claim dragged all the way through the 90 days. The insurance company wanted one thing after another. It was stressful beyond belief. Well, they honored the policy at the last minute and have paid every penny of care ever since, for 2.5 years. So, don't get discouraged! During that 90 days, I kept waiting for them to deny his claim, but maybe they were just hoping he would end up coming home, or dying, or who knows what.

I would call up the state insurance commission and find out if what they are doing is legal and if it is the norm.

I would also contact local press (consumer advocate in local print and broadcast press), local elected officials (the all have elder affairs specialists) and ask for them to advocate on your behalf with JH.