Long Term Care Insurance

(LTC)

Insurance Education Part #5

Features•Available to employee, spouse, parents and parents-in-law Medical evidence of good health required for spouse, parents and parents-in-law

Insured by Aetna

•To receive benefits, subscriber must be unable to perform certain activities of daily living (ADLs), varying with subscriber’s LTC plan chosen

Long Term Care Insurance

•Examples of ADLs Bathing Eating Dressing Transferring Continence Toileting

(cont.)

Insured by Aetna

Long Term Care Insurance

•Benefits allowed, according to plan of choice, for in-home care, nursing home or adult daycare facility Service Reimbursement Plan - must be unable to perform two of the six ADLs

Disability Plan - must be unable to perform three of the six ADLs

(cont.)

Insured by Aetna

Long Term Care Insurance

•Benefits also for custodial care for chronic, long-lasting diseases or disabilities, including Alzheimer’s disease

(cont.)

Insured by Aetna

Long Term Care Insurance

Premiums•Based on:

Age at time of purchase Selected daily benefit amount

•May continue coverage upon retirement or leaving employment

Insured by Aetna

Long Term Care Insurance

Disability Plan•Cash benefit, regardless of expenses incurred

•$50 - $250 Daily Benefit Amount (DBA) options

Insured by Aetna

Long Term Care Insurance

•May increase coverage (“buy-up”) Under inflation protection every two years without evidence of good health

While receiving benefits as long as subscriber has not turned down previous offer to increase coverage under inflation protection

(cont.)

Insured by Aetna

Long Term Care Insurance

Insured by Aetna

Long Term Care Insurance

(cont.)

•Restoration of benefits feature Restore lifetime maximum if

• Subscriber recovers (certain limitations apply) and

• Has not been exhausted

Service Reimbursement Plan•Reimbursement of expenses for defined set of covered services

•$50 - $350 daily benefit amount (DBA)

Insured by Aetna

Long Term Care Insurance

Insured by Aetna

Long Term Care Insurance

(cont.)

•May increase coverage (“buy-up”) under inflation protection Every two years without evidence of good health

While receiving benefits as long as subscriber has not turned down previous offer to increase coverage under inflation protection

Insured by Aetna

Long Term Care Insurance

(cont.)

•Restoration of benefits feature Restore lifetime maximum if

• Subscriber recovers (certain limitations apply) and

• Has not been exhausted

Plan Features Disability Plan Service PlanBenefit Triggers(ADLs: Bathing, dressing, eating, toileting, transferring, continence)

3 out of 6 ADLs or if subscriber has severe cognitive impairment

2 out of 6 ADLs or if subscriber has severe cognitive impairment

Expenses Covered Nursing home: 100% of daily benefit amount (DBA)Assisted living: 50% of DBA*

Community-based services:50% of DBA*

Nursing home: 100% of DBA*

Assisted living: 100% of DBA*

Community-based services: 50% or 100% of DBA*

Spousal Premium Discount

N/A 10% - for both employee/retiree & spouse

Insured by Aetna

Long Term Care Insurance