Description: Bringing managed care concepts into LTC claims management could benefit insurers, policyholders, and providers. This article outlines the case for doing so, and articulates the benefits to each stakeholder in the LTC claims process.

Description: While tax-qualified products meet an existing demand in the long-term care market, the statutorily required language of Section 7702B can present challenges as claims are presented. Every day, claims professionals grapple with whether the facts of a claim constitute substantial assistance or a severe cognitive impairment. “Close call” claims decisions continue to increase as claims volumes rise across the long-term care insurance sector. This article analyzes the Section 7702B language, identifies potential pitfalls in administering claims made on tax-qualified policies, and illustrates how to avoid such pitfalls through hypothetical scenarios.