limitations exclusions covered long term insurance policy coordination benefits advice law advice insurance advice community law advice case evaluation ask lawyer amp legal topics legal topics accident law bankruptcy law business law criminal law employment labor law estate planning family law financial law general practice government law immigration law insurance law intellectual property litigation malpractice law personal injury real estate law tax law small claims admiralty maritime aviation law insurance law topics insurance law topics insurance law basicsauto insurancebusiness insurancelong term caredisability insurancehealth insuranceinsurance bad faith life insurance lawproperty insuranceviaticals advice law advice insurance law long term care current limitations exclusions covered long term insurance policy coordination benefits written freeadvice staff insurance claim denied delayed case evaluation call provisions sample long term care insurance policy clearly state specific conditions benefits paid policies contain provisions similar outlined payment following treatment alcoholism drug addiction addiction due drug taken advice physician care received hospital unit specifically designated nursing hospice facility injury sickness results war act war declared undeclared participation felony riot insurrection intentionally self inflicted injury services performed member immediate family care services received outside untied states territories described international coverage section service supply extent expense reimbursable medicare reimbursable application deductible coinsurance payment amount exclusion apply medicare secondary applicable law treatment received government facility required law services benefits available government program medicaid services charge normally absence insurance limitations exclusions pre existing conditions mental nervous disorders including disease comment note exclusions relate conditions caused condition presumed brought words self induced alcoholism drug addiction participation felony riot insurrection self inflicted injury services performed immediate family covered presumed done family charge charge service performed immediate family member considered legitimate regarded charged insurance law medicare secondary means insurance company pays medicare primary insurance company need pay medicare regular health insurance limitations exclusions pre existing conditions mental nervous disorders coordination coverages company provisions sample long term care insurance policy clearly state specific conditions benefits paid policies contain provisions similar outlined long term care insurance policy certificate issued insured company reduce benefit amounts payable extent necessary combination benefits policies certificates exceed cent actual charges covered services eligible receive benefits policy long term care insurance policy certificate issued insured company coordination benefits provision policy certificate earliest effective date deemed tore primary coverage policy certificate deemed secondary coverage order effective date earliest latest policies certificates coordination benefits provision pay comment coordination benefit provisions complicated apply policy may priority system policy pays second goal course protect profiteering provision apply policies certificates pay benefits regard actual charges incur comment example long term care policy providing long term care diem basis policy pays international coverage example coordination benefits apply theory coordination benefits keep individual profiting insurance buying bunch policies designed intended cover incurred long term care expenses collecting essence multiple benefit payments incurred expenses contrary basic insurance concept diem benefit designed priced pay specific daily benefit regardless expenses incur insurance claim denied delayed case evaluation call view related sample long term care policy provisions articles view faq insurance legal topics insurance attorney ask lawyer looking social read articlesgeneral provisions long term care policyhome care community care benefitsinternational long term care coveragelimitations exclusions covered long term insurance policy coordination hellip long term care claims notice forms prooflong term care extension benefits long term care insurance policy schedule benefits select practice area adoption support amp child custody arbitration aviation maritime amp boat accident banking bankruptcy business car accident civil rights amp ada collection construction contract copyright ip amp trademark criminal dui dwi divorce education law elder law employment environmental estate planning franchise general practice government healthcare nursing abuse immigration insurance international juvenile landlord tenant legal malpractice lemon law libel amp slander litigation medical malpractice military patent pensions amp benefit personal injury product liability 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Limitations and Exclusions What is Not Covered Under Long Term Insurance Policy Coordination of Benefits Free Advice Law Advice Insurance Advice Community Law Advice Free Case Evaluation Ask a Lawyer Q amp A Legal Topics All Legal Topics Accident Law Bankruptcy Law Business Law Criminal Law Employment Labor Law Estate Planning Family Law Financial Law General Practice Government Law Immigration Law Insurance Law Intellectual Property Litigation Malpractice Law Personal Injury Real Estate Law Tax Law Small Claims Admiralty Maritime Aviation Law Insurance Law Topics All Insurance Law Topics Insurance Law BasicsAuto InsuranceBusiness InsuranceLong Term CareDisability InsuranceHealth InsuranceInsurance Bad Faith Life Insurance LawProperty InsuranceViaticals Free Advice Law Advice Insurance Law Long Term Care Current Page Limitations and Exclusions What is Not Covered Under Long Term Insurance Policy Coordination of Benefits Written by FreeAdvice Staff Insurance Claim Denied or Delayed Click here for a FREE Case Evaluation or call The provisions in the sample long term care insurance policy clearly state the specific conditions under which benefits will not be paid Most policies contain provisions similar to those outlined below No payment will be made for any of the following Treatment of alcoholism or drug addiction unless the addiction was due to drug s taken on the advice of a Physician Any care received while in a Hospital except in a unit specifically designated as a Nursing Home or a Hospice facility Any injury or sickness that results from any war or act of war whether declared or undeclared or participation in a felony riot or insurrection Any intentionally self inflicted injury Services performed by a member of Your Immediate Family Any care or services received outside of the Untied States and its territories except as described in the International Coverage section Any service or supply to the extent the expense for it is reimbursable under Medicare or would be reimbursable but for the application of a deductible coinsurance or co payment amount This exclusion will not apply where Medicare is a secondary under the applicable law Treatment received in a government facility unless otherwise required by law services for which benefits are available under a government program except Medicaid or services for which no charge is normally made in the absence of insurance There are no limitations or exclusions for pre existing conditions or mental and nervous disorders including Alzheimer's Disease COMMENT Note that many of the exclusions relate to conditions caused by a condition presumed to be brought on by yourself in other words self induced alcoholism drug addiction participation in a felony riot or insurrection self inflicted injury Services performed by your Immediate Family are not covered because it is presumed that they will be done by the family for no charge A charge for a service performed by an Immediate Family member is not considered to be legitimate It is regarded as one which would not be charged if there were no insurance If under the law Medicare is secondary that means that your insurance company pays first If Medicare is primary then your insurance company need not pay because Medicare will Unlike regular health insurance there are no limitations or exclusions for pre existing conditions and mental and nervous disorders Coordination of Other Coverages with This Company The provisions in the sample long term care insurance policy clearly state the specific conditions under which benefits will be paid Most policies contain provisions similar to those outlined below If you have more than one long term care insurance policy or certificate issued or insured with this Company We will reduce the benefit amounts payable to the extent necessary so that the combination of Benefits under all of these policies and certificates will not exceed one hundred per cent of the actual charges for Covered Services If you are eligible to receive Benefits under this Policy and any other long term care insurance policy or certificate issued or insured by this Company with a coordination of benefits provision then the policy or certificate with the earliest effective date will be deemed tore be the primary coverage and any other policy or certificate will be deemed secondary coverage in order by effective date from the earliest to the latest Policies and certificates without a coordination of benefits provision will pay first COMMENT Coordination of benefit provisions can be very complicated to apply because each policy may have its own priority system for which policy pays first second etc The goal of course is to protect against profiteering The provision will not apply to policies or certificates which pay Benefits without regard to actual charges you incur COMMENT For example if another long term care policy was providing long term care on a per diem basis like this Policy pays for International Coverage for example coordination of benefits would not apply That is because the theory behind coordination of benefits is to keep an individual from profiting from insurance by buying a bunch of policies that are designed and intended to help you cover your incurred long term care expenses and collecting in essence multiple benefit payments for the same incurred expenses This is contrary to the basic insurance concept A per diem benefit is not designed to do that It is priced to pay you a specific daily benefit regardless of expenses you incur Insurance Claim Denied or Delayed Click here for a FREE Case Evaluation or call View Related Sample Long Term Care Policy and Provisions Articles View the Next FAQ Insurance Homepage All Legal Topics Find a Insurance Attorney Ask a Lawyer Didn't find what you were looking for Make it Social Must Read ArticlesGeneral Provisions of Long Term Care PolicyHome Care and Community Care BenefitsInternational Long Term Care CoverageLimitations and 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