Claims Experience

An Analysis of Connecticut Partnership Policyholder Claimants
Reprint Series #7-2008 (Updates Discussion Paper #12-2002)

Authors: Laurie Kyzivat and Patricia H. Kelleher, both from the State of Connecticut's Partnership for Long-Term Care
Published as a Connecticut Partnership Research Institute Discussion Paper.

EXECUTIVE SUMMARY

The Connecticut Partnership for Long-Term Care (Partnership) is a unique alliance between State government and the private insurance industry developed to: 1) provide individuals with a way to plan for their long-term care needs without the risk of impoverishment; 2) enhance the standards of private long-term care insurance; 3) provide public education about long-term care; and 4) conserve State Medicaid funds. Connecticut was the first state in the country to implement a Partnership program. The program has been in operation since April, 1992.

The Uniform Data Set (UDS) is the data reporting requirements and documentation developed collaboratively among the four original Partnership states (Connecticut, New York, California, Indiana), the National Partnership Program Office at George Mason University, and the Program Evaluator, Laguna Research Associates. The UDS was specifically designed to provide a single reporting format for use by all of the long-term care insurance providers participating in each of the four Partnership states.

As part of the UDS, each participating company is required to send to the Office of Policy and Management (OPM is the State agency that administers the Connecticut Partnership) detailed information on each Partnership claim that is filed, including assessment information and service utilization, on a quarterly basis. This includes information such as: date and outcome of assessment, functional and behavioral status, cognitive test scores, services utilization, and amounts billed, paid, and protected.

In addition to the collection of the UDS data, each quarter the Partnership conducts a Survey of Persons Purchasing Partnership Insurance, also known as the Baseline Survey. For purposes of this paper, the Baseline Survey data was linked with the UDS data for 341 of the 612 claimants who reported service use to obtain more comprehensive demographic information about claimants who responded to the survey.

This paper focuses on claims data received through June 30, 2007. As of that date, 44,806 Connecticut Partnership policies had been purchased and 726 policyholders had filed claims since the inception of the Connecticut Partnership in April, 1992. Of these 726 people, 699 (96%) were determined eligible for benefits under their Partnership policy.  Subsequently, services/payment data was received for 612 of the 699 eligible claimants, leaving 87 claimants for whom no services/payment activity was reported.  The focus of this paper will be the 612 claimants for whom service utilization and payment data was reported through June 30, 2007.

For more information contact:
David Guttchen, Director
David.Guttchen@ct.gov
(860) 418-6318