'96 Transamerica LTC Policy

Discussion in 'Senior Insurance Forum' started by Bob_The_Insurance_Guy, Aug 16, 2012.

  1. Bob_The_Insurance_Guy
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    Bob_The_Insurance_Guy Guru

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    I met a couple who has a Transamerica LTC Policy, effective date 1/96. The husband is in a Nursing Home, but is being relocated to an Assisted Living Facility.

    His doctors have already made the determination that he needs help, and will need on-going assistance, with 3 of the 6 ADL's. While he was in the Nursing Home, Transamerica did not make them pay the monthly premium for the policy (of course, because he qualified for claim); however, they told them that the policy does not do the same for an Assisted Living Facility. They would have to go back to making the monthly premium payments, now that he is in an Assisted Living Facility

    I am not familiar with Transamerica's LTC products. Does this sound right?

    P.S. when the wife questioned it, she was told that the law changed shortly after their policy went into effect.

    I read through their policy, and did not see any such disclaimer or rider to that effect.
     
  2. Mink
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    Does not sound right. It probably makes no difference between NH and ALCF. They need to ask again. The law they might be referring to is if the policy is a tax qualified policy or not. It should not matter in this case.
     
  3. moonlightandmargaritas
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    Waiver of premium must be defined in the contract. What does it say?
     
  4. G.Gordon
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    +1

    Does not matter what customer services says or what we think. The words in the contract dictate no matter when a "law changed"... a "law" does not alter a contract.
     
  5. Bob_The_Insurance_Guy
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    I read the contract, and under Waiver of Premium, it did not distinguish between NH and ALF.
     
  6. moonlightandmargaritas
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    I would say that your guy stays on WoP then.
     
  7. G.Gordon
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    Yep, if it does not distinguish and only says "while on benefit or while receiving benefits"... then they have grounds to argue their point. All the way to filing a complaint if needed.
     
  8. billberry12
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    She might have a "nursing home only policy." Many of those were available back then, and a lot of folks were mainly concerned with going to the nursing home. They were much less expensive than comprehensive policies.

    BUT, my mother in law had a Transamerica policy that paid for an assisted living facility for three years. She purchased it pre-1996.
     
  9. Bob_The_Insurance_Guy
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    @billberry could be true.

    I'm trying to locate a local Transamerica agent, who can go over there and take a look see.
     
  10. bluemarlin08
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    My bet it is a nursing home only policy and if so they will have to continue making premiums and the AL payment.
     
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