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Long-Term Care

This insurance covers certain services required by individuals who are no longer able to care for themselves without the assistance of others. Natural aging, a serious illness or an accident may bring on this need. Services covered include nursing home care, assisted living, home health care, home care and adult day care. Benefits are available through different options based on a daily benefit amount ($100, $150 or $200) for either a three-year or five-year coverage period. The benefits are also available with or without inflation protection.

In addition to these choices, there are a number of fixed features. There is a 90-day period that must be met — much like a deductible — by having a person qualify for services before the insurance coverage begins to pay for those services. The plan covers respite care, providing care for up to 21 days per calendar year at home or in a facility to give the primary caregiver a rest. Bed reservation is also covered for up to 21 days per calendar year to hold your bed in an assisted living facility, nursing home or hospice facility if you have to go to the hospital. The plan also covers home health agency services for household tasks that do not require a trained home health aide.

The plan is guaranteed renewable, which means it can never be canceled as long as you pay your premium. The coverage is portable, so you may continue to pay premiums directly to the insurance company under the same terms and conditions as active employees if you leave employment. The plan includes a waiver of premium so that if you qualify for benefits and satisfy the 90-day period, you can stop payment of premium and the coverage will remain in effect.

State and higher education members are eligible to apply for optional long-term care coverage at any time. Effective January 1, 2012, this coverage will also be available to local education and local government employees (if offered by your agency). Local education and local government retirees are also eligible for coverage regardless of whether or not your former employing agency chooses to participate.

The premiums for long-term care insurance are based on your age at the time of enrollment. Therefore, the younger you are when you apply, the lower your monthly premium will be.