How is the long term care insurance elimination period counted?

The elimination period is the stretch of days at the start of a claim when the policy pays nothing. The NAIC's consumer guide says it can be 20, 30, 60, 90 or 100 days. FLTCIP's current guide says its waiting period is 90 calendar days. A published Genworth sample group policy also lists 90 calendar days.

The number of days matters less than how they are counted. Two policies with the same 90-day period can take very different amounts of time to satisfy.

What is an elimination period?

The NAIC's A Shopper's Guide to Long-Term Care Insurance defines it as "A type of deductible; the length of time the individual must pay for covered services." Some insurers, including FLTCIP, call it a waiting period. MetLife's claims page uses both terms together: "waiting/elimination period."

Your schedule of benefits (the page near the front of the policy or certificate) shows the length. Genworth's sample group policy says the schedule also states "whether it is based on calendar days or days on which an Insured receives Covered Care."

What is the difference between calendar days and service days?

The NAIC guide explains both methods:

Calendar days: "every day that you satisfy the benefit triggers count toward the elimination period." The guide adds that "many coverages will not start counting those days until you incur costs."
Service days: "only the days that you pay for professional care services covered by the policy count toward the elimination period."

The NAIC guide notes that someone using paid care three days a week takes longer to satisfy a service-day period than someone using it five days a week. Using that example with 90 service days, three days a week works out to 30 weeks of care, and five days a week works out to 18 weeks. A 90 calendar day period is about 13 weeks.

FLTCIP's Using Your Benefits page describes both types. A calendar day period is "the number of calendar days you must be eligible for benefits before we'll pay." A service day period is "the number of days you must be eligible for benefits and receiving and paying for care."

When does the elimination period start?

It starts once the insured meets the policy's benefit triggers, and some policies add a cost requirement.

Genworth's sample group policy says the period "is satisfied by days an Insured is Chronically Ill," starting with the first day the insured incurs a Covered Expense.
The NAIC guide says many calendar-day policies don't start counting until costs are incurred.
FLTCIP's page says services "must be paid at the time rendered," and that services paid in cash "cannot be validated to count toward the waiting period or be reimbursed."

Your policy's wording sets the exact start rule, so read the elimination period section alongside the definition of a benefit trigger.

Do elimination period days have to be in a row?

Not under the policies reviewed here.

Genworth's sample group policy: "Days used to satisfy the Elimination Period do not need to be consecutive; and can be accumulated over time."
FLTCIP 2.0 Benefit Booklet: days "need not be consecutive, nor associated with the same episode of care."
FLTCIP's 2.0 and 3.0 guide: if you recover during the waiting period, accumulated days "will be applied to any future instances of becoming benefit eligible."

The NAIC guide does not say whether days must be consecutive in general, so read the policy's own language.

Is the elimination period once per lifetime?

It depends on the policy. The NAIC guide says, "Some policies only require you to meet the elimination period once in your lifetime." Others "require you to satisfy the elimination period with each 'episode of care.'"

Published examples of the once-per-lifetime approach:

FLTCIP: "You only have to satisfy your current plan's waiting period once in your lifetime."
Genworth's sample group policy: "Once satisfied, an Insured will never have to satisfy a new Elimination Period for Coverage."

Do you need invoices during the elimination period?

Insurers' instructions differ here.

John Hancock asks for itemized invoices so you get "appropriate credit toward the elimination period as quickly as possible," and its claims page suggests sending them within 30 days of receiving care. It also asks for Medicare UB04 forms if you want Medicare-covered services to count.
MetLife says "Invoices/UB04 need to be submitted to verify the days applied towards the waiting/elimination period," and that it can often count days even when Medicare or another payer covered them.
FLTCIP's 2.0 and 3.0 guide says, "It is not necessary to submit invoices for care received during the waiting period." Its reimbursement page adds that plans with a service day waiting period do need invoices to satisfy it.

Even when invoices aren't required, keeping dated timesheets and proof of payment for those days gives you a record if the count is ever questioned.

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Does family care count toward the elimination period?

Often it does not. The NAIC guide says most policies don't pay family caregivers and may not count their care toward the elimination period. FLTCIP's page requires proof of payment for informal caregiver services used toward a waiting period.

Do any benefits skip the elimination period?

Some do. FLTCIP's page lists hospice, respite, caregiver training and the stay-at-home benefit as paid without a waiting period, and says they don't count toward a service-day waiting period. Your policy's schedule of benefits will show any equivalent.

How do you track elimination days?

Keep one running log with a line for each day:

Date and whether paid care was received.
Caregiver or provider name.
Hours, amount paid and payment method.
Whether an invoice or UB04 was sent, and when.

Then compare your count with the insurer's. FLTCIP's online dashboard shows claim and invoice status, and John Hancock's and Genworth's online accounts let you manage the claim.

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This is general information, not legal, tax or insurance advice. Your policy and your claim approval letter control how your elimination period is counted.

FAQ

Is a 90-day elimination period 90 days of care?

Only if the policy counts service days. Under a calendar-day policy, the NAIC guide says every day the benefit triggers are met counts, though many policies start counting only once costs are incurred.

Do I have to meet the elimination period again on a second claim?

FLTCIP and Genworth's sample group policy say it is satisfied once in a lifetime. The NAIC guide says some other policies require it again for each episode of care.

Do Medicare-covered days count?

John Hancock and MetLife both say Medicare UB04 forms can be submitted to have those days counted toward the elimination period.

Sources:
https://content.naic.org/sites/default/files/publication-ltc-lp-shoppers-guide-long-term.pdf
https://www.ltcfeds.gov/claims-information/using-your-benefits
https://www.ltcfeds.gov/claims-information/reimbursement
https://cdn.ltcfeds.gov/planning-tools/downloads/2.0-3.0-Using-Your-FLTCIP-Benefits.pdf
https://cdn.ltcfeds.gov/planning-tools/downloads/2.0-Benefit-Booklet.pdf
https://cdn.ltcfeds.gov/planning-tools/downloads/3.0-Benefit-Booklet.pdf
https://www.genworth.com/dam/Americas/US/PDFs/Consumer/Product/LTC/7053POL%20CA%20Sample.pdf
https://www.johnhancock.com/individual/help-center/long-term-care/claims
https://www.johnhancock.com/help-center/long-term-care/understanding-the-claim-process/determine-benefit-eligibility.html
https://www.metlife.com/ltc/ltc-claims-process-claim-reimbursement