Exemptions to the Individual Mandate
There are some cases where there is no penalty to not having coverage.
Companies selling long-term care insurance “underwrite” their coverage. This means the company looks at your health and health history before it issues you a policy. If you do not meet the guidelines established by the company, you may not qualify for coverage.
Some companies do what is known as “short-form” underwriting. On the application for coverage, they will ask you to answer just a few questions about your health.
No matter what kind of underwriting a company uses, it is important to answer all health questions as truthfully as possible.
A copy of your application generally will be attached to your policy. Review this application:
Companies may impose a waiting period for "pre-existing conditions". This means that policy benefits will not be paid for services related to conditions which existed before you purchased the policy.
Generally, your premium is based on the following:
Age — The younger you are when you buy a policy, the less you pay in premiums.
Elimination period — Premiums are less if you increase the elimination period. The longer you can wait for benefits to begin, the lower your premium will be.
Benefits — A policy paying $50 a day for three years will cost less than one paying $100 a day for five years. To decide the benefit amount you would like to have, multiply an estimated daily cost of care and by the number of days of care for which you want coverage.
(Dollar amount per day) X (Number of days) = (Policy coverage or benefit amount)
Other factors — Where you live, your health at the time the policy is issued, and any optional benefits you decide to add to your policy may increase your costs.
Premiums on long-term care policies will probably increase in the future.
Insurance companies may raise the premiums on their policies but only if they increase the premiums on all policies. No individual can be singled out for a rate increase, regardless of the number of claims they’ve filed.
Kansas laws allow policies to have these exclusions:
This article is published on KansasMoney.gov. Find more information by contacting these state agencies: