Dependence refers to a situation in which a person cannot look after themselves. Increased life expectancy is leading to a progressive increase in the number of dependent people; in addition to this fact, we need to add dependence for reasons of illness and other causes of disability or personal limitation. For this reason, the law has included a system of public benefits based on subsidies for caring for people who are in a dependent situation. Meanwhile, insurance companies are developing complementary products to address these needs.
This type of insurance guarantees compensation in the form of income, capital or the provision of a service, provided that the insured person is in a dependent situation.
In legal terms, a person is dependent when the following factors occur:
- There is a physical, mental or intellectual limitation.
- The person is not capable of doing daily activities on their own.
- There is a need for the assistance of another person.
For example, the following people would be considered to be in a dependent situation:
- People in wheelchairs who do not need help with daily activities such as getting dressed or eating, but do need help to deal with certain architectural barriers, such as getting on a bus.
- Sick people who depend on their families or other people to perform everyday tasks for them, such as washing them, getting them out of bed, helping them to eat, etc.
The different types of coverage offered by insurance companies are essentially based on:
Payment of a cash amount
The basic coverage is usually as follows:
- Payment of an income
- Payment of a capital amount
- Travel and accommodation expenses of a family member in the household of the insured person if they are in a dependent situation following a hospital stay.
Provision of a service
As a general rule, the following are included:
- The cost of staying in a residential home, a day care center or a hospice, depending on the needs of the insured person.
- Guaranteed bed: this covers the cost of a bed in the insured person’s care center for a certain number of days per year.
- Home care services: this covers home support services and personal care services.
- Remote assistance: a program for supporting senior citizens or people with disabilities who live alone, providing communication, independence and security in situations of need, by means of a device with which they can communicate with the service concerned so it can provide the necessary assistance.
There are other additional guarantees to the main coverage of insurance for dependent people. Some of these are:
- International coverage: this covers temporary stays abroad provided that these stays do not exceed a certain time, which is usually between three and six months.
- Training of caregivers.
- Compensation in the event of hospitalization.
To access the policy’s coverage, the insured person must be able to fulfil a series of additional conditions to the usual administrative requirements:
- Medical requirements: the insurance company may ask the insured person to complete a health questionnaire to evaluate the specific coverage it is able to offer them.
- Pre-existing illnesses: the insurance company may exclude any compensation payments for incidents that are the direct result of a pre-existing illness, taking the abovementioned health questionnaire into account.
The most common exclusions are as follows:
- Any illness or disability the insured person knows about before the insurance policy goes into effect.
- Attempted suicide.
- Scams or illicit acts perpetrated by the insured person.
- Events declared by the national government as being a “national catastrophe or disaster”.