Lecture Notes
(from Instructor's Manual by Ronald J. Schwartz, J.D., L.L.M. for textbook
Law and Aging - Essentials of Elder Law - 1st Edition - Pearson Publications)

Managed Care and Long Term Care Insurance & Viatical Settlements

Topical Outline
a. Introduction to Health Maintenance Organizations (HMO)
   (1) Benefits
   (2) Capitation Process
   (3) Gag Clauses
   (4) HOMs and Long-Term Care
b. Long-Term Care Insurance
   (1) Historical background
   (2) Use as a financial planning tool for the well elderly
   (3) Analysis of the basic long-term care insurance policy
c. Viatical Settlements


Learning Objectives
a. to be able to understand how an HMO operates
b. to understand what long-term care Insurance is
c. to understand how long-term care is an integral part of financial planning for the elderly
d. to understand the basic long-term care insurance policy:
   (1) rating
   (2) levels of care
   (3) hospital stay
   (4) coverage of certain illnesses
   (5) covered facilities
   (6) preexisiting conditions
   (7) waiver of premium
   (8) guarantee of renewability
   (9) daily benefit amount
   (10) payment of long-term care insurance benefits, in addition to other coverages
   (11) level of premium
   (12) age limits
   (13) coverage should be reviewed after policy issued
   (14) inflation guard
   (15) term of policy
   (16) deductible period
   (17) convalescent benefits at home
e. to learn how a viatical settlement operates
f. to communicate with viatical settlement companes and to obtain any information necessary to prepare a favorable viatical settlement for a client

Job Competencies
a. to be able to read and understand a long-term care insurance policy and advise the client about its benefits and restrictions.
b. to assist a client apply for long-term care insurance
c. to assist a client determine what coverage they should obtain.

Key Concepts
It is important to understand how an Healthcare Maintenance Organization (HMO) works. The paralegal also should understand what th advantages and disadvantages are and what the client-subscriber's rights are in the event he or she does not receive what has been contracted for with the HMO.

It is crucial to understand how long-term care insurance fits into Medicaid planning, as the client ages. The paralegal should have a basic understanding of long-term care insurance policies, their benefits and restrictions, and how such insurance can avoid a financial disaster in the event of catostrophic illness. Assisting a client in this area is a key role for the paralegal.

It is also crucial for the paralegal to understand the nature of viatical settlments and how they can also be used to relieve the financial burden of catostrophic illness.