Care Insurance, If you wish to protect yourself against the loss of autonomy, you can take out a long-term care insurance contract covering the costs of personal services, care or accommodation in a retirement home.
The long-term care insurance contract guarantees the subscriber financial protection in the event of loss of autonomy. At what age should you subscribe? What are the points to check before committing? All the answers and explanations.
What is addiction?
Whether physical or psychological, addiction is often poorly anticipated and complicates or even prevents the performance of acts and activities of daily living (moving, dressing, eating). It can have various origins such as aging, illness or an accident.
Dependence can be light, partial or heavy. To determine the degree of dependence of their customers, insurers rely on the AGGIR grids (Autonomy, Gerontology, Iso-Resources Groups or GIR) and criteria for acts of daily living. Additional psychotechnical tests are sometimes necessary. A person assessed at GIR 1 is considered to be heavily dependent and their condition requires continuous presence. Conversely, a person evaluated at GIR 6 is considered autonomous to perform the essential acts of everyday life.
What support is offered to dependent elderly people?
Dependent elderly people can benefit from the personalized autonomy allowance (APA) to pay for the expenses necessary to stay at home or pay part of the dependency rate of the medico-social establishment in which they are accommodated. The rules for allocating and calculating this aid differ depending on whether the beneficiary is accommodated at home or in an establishment.
The APA can be obtained from the GIR 4. Before the age of 60, this allowance is granted by the insurer’s medical advisor. After 60 years, it is the medico-social team of the Departmental Council of the place of residence of the person in charge of the evaluation of the dependence which takes the decision.
Beyond the physical and mental consequences caused by addiction, the emotional suffering suffered by loved ones should not be overlooked. In addition, the amount of the APA is capped at a maximum of 1719 euros, an aid which may prove to be insufficient depending on the level of dependence and the income of the person concerned. Dependency insurance offers personalized support adapted to the loss of autonomy.
Which contracts guarantee dependency risk?
Several players are involved in the market to guarantee dependency risk: insurers, health mutuals, provident institutions.
Two types of contracts can be offered:
- An individual contract: signed without an intermediary between the insurer and its client;
- A collective contract: taken out by a company, a mutual insurance company or an association. The insured then does not have the quality of subscriber but of beneficiary.
Some contracts may be labelled. The French Insurance Federation (FFA), for example, issues the GAD or Garantie Assurance Dépendance label to contracts that meet several criteria, such as the payment of a minimum pension of 500 euros in the event of heavy dependency, the maintenance of part of the rights in the event of non-payment of contributions, the absence of medical selection.
Focus on the individual long-term care insurance contract
Insurers who guarantee long-term care risk offer two types of contracts:
This contract allows the insured who becomes dependent to receive the benefit provided in the form of a monthly annuity or capital. This payment is usually accompanied by assistance services.
If the dependency risk does not occur before the subscriber’s death, the contributions paid are definitively lost because they are not part of the estate.
Life insurance contracts
Subscribers to a life insurance policy can take out optional long-term care cover. If the insured becomes dependent before the end of the contract, a fraction of the capital converted into a monthly annuity will be paid to him.
What are the guarantees offered by long-term care insurance?
Dependency insurance can guarantee total dependence or partial dependence and provides the conditions for implementing this guarantee.
Insurance contracts define total dependence as the impossibility of performing at least four of the following five acts without outside help: washing, moving around, dressing, eating, grooming. When the total state of dependence is confirmed by the doctor or the insurer, the guarantee provides for 100% coverage.
Insurance contracts can also cover partial dependency cover , which is characterized by the need for help with up to three of the five ordinary acts of daily living. The amount of the pension paid then corresponds to a percentage of the amount provided for in the event of total dependence.
Finally, these contracts may provide for the payment of additional services such as an assistance service allowing the insured to be oriented to find the appropriate establishment and set up home help services, or psychological support. .
Dependency insurance: what are the points to check before subscribing?
Before taking out or joining a long-term care insurance contract, it is important to pay attention to the following points:
- Subscription conditions: subscription to the long-term care insurance contract must be anticipated. To accept or refuse a membership application, the insurer bases itself on the information relating to the state of health gathered by the doctor. You should know that it is generally not possible to subscribe after the age of 75.
- The amount of contributions: insurance premiums depend mainly on the age at which the insured subscribes to the contract. The older he is, the higher the premium.
- The deductible period: once the state of dependence has been established, some insurers apply a deductible period of up to 90 days. During this period, no benefits can be provided.
- The waiting period: this is a period that starts from the date of membership and during which the insured is not guaranteed. However, this period does not apply in the event of dependence of accidental origin.
- Guarantees: not all contracts offer the same services. It is necessary to determine the most profitable offer and the most adapted to your situation.
- The warranty exclusionsappearing in the general or special conditions of the contract.
To find the best long-term care insurance contract , it is strongly advised to compare the offers. After filling out a form with some information about your state of health and the guarantees you want, you will receive 100% personalized, free and non-binding quotes. To help you make the right choice, you can also call on a broker who will compare the offers for you.