Long Term Care

Summary Information Only

This webpage presents summary information only. Any error or omission here is unintentional and will be resolved in favor of plan documents or applicable federal or state law or rule.

Plan Documents

Enrolling

Members eligible for long term care insurance can enroll for coverage at any time - not just during Open Enrollment. During Open Enrollment, you can begin the enrollment process online through your record in the benefit system; however, you will still need to submit forms to the carrier - UNUM.

Eligibility & Effective Dates 
 
All PEBB-eligible employees who are 18 to 84 years old are eligible to enroll in long-term care insurance. The following individuals in the same age range are also eligible:

• The employee's spouse or domestic partner
• Parents and grandparents of the employee or of the employee’s spouse or domestic partner
• Adult siblings or adult children of the employee or the employee’s spouse or domestic partner
• Non-Medicare eligible retirees and retirees' spouse or domestic partner.

Other family members 18 to 84 years of age who may enroll include the following: Your and your spouse' or domestic partner's parents and grandparents, adult siblings and adult children
 
Family Members may enroll only with UNUM approval of the Evidence of Insurability Application. 
 
This insurance goes into effect the first of the month following your enrollment (if it is guarantee issue) or the first of the month following the insurance carriers approval.

Your initial coverage will not begin if you are absent from work because of injury, sickness, temporary lay off or leave of absence on the date that the coverage would normally begin. Coverage begins one minute after midnight on the first day of the month after you return to work.

Description of Benefit

You are eligible for a monthly benefit after:

• You become disabled
• You are receiving services in a long term care facility or assisted living facility or adult foster home; or professional home care services if your plan includes a professional home care services benefit; or total home care if your plan includes a total home care benefit;
• You have satisfied your elimination period; and
• A physician has certified that you are unable to perform, without substantial assistance from another individual, two or more activities of daily living (ADLs) for a period of at least 90 days, or that you require substantial supervision by another individual to protect you and others from threats to health or safety due to severe cognitive impairment. You will be required to submit a physician certification every 12 months.

A monthly benefit will become payable once all of these requirements are met. The treatment and services you receive for your disability must be provided pursuant to a written plan of care developed by a licensed health care practitioner. 
 
If you have an existing loss of ADLs or severe cognitive impairment on your effective date of coverage, that loss or impairment will only be eligible for coverage if you recover from that loss or impairment. The insurance carrier must receive acceptable proof of your ADL or cognitive recovery, such as a physician’s statement or an assessment.

The amount of your monthly benefit will be based on the coverage options you chose and the place of residence used for long term care. If your coverage includes professional home care services, the benefit payment will be based on the number of days you receive these services. 

Total Home Care Benefit

You will receive the monthly total home care benefit amount if you are disabled and you choose to receive care anywhere other than in a long term care facility or assisted living facility. 

This care can be provided at any type of facility, such as an adult day care facility or your home.

Care can be provided to you by:

• A formal caregiver, such as a licensed home health care provider, a registered nurse, a licensed practical nurse
• An informal caregiver, such as a friend or relative

Guarantee Issue

Newly Hired Employees – Will have 30 days from date of hire to sign up for Guarantee Issue coverage. Coverage is effective the first of the month following the date your Benefit Election Form is received by the agency.

Guarantee Issue – As an Employee you are eligible for benefit amounts on a guarantee Issue basis of up to and including $4,000 and a facility Benefit Duration of 3 or 6 years. Completion of the Benefit Election Form is required for enrollment. This does not require completion of the Long Term Care Insurance Application (medical questionnaire) if you are applying during your initial eligibility period.

Premium Rates

You may choose from $1,000 - $6,000 in Facility monthly Benefit. Your monthly Premium will equal the monthly rate for the plan you choose times the facility monthly benefit amount per thousand.

Unum Rate Estimator

Premium Rate Increases

Increasing your coverage will not increase the premium for initial coverage. However, the premium to pay for increased coverage will go up as it will tie to your age when the increase goes into effect.

Unum has the Right to Change Premiums. The rate will not increase because you grow older or because of your use of the benefits. However, the rate schedule may change in the future depending on the overall use of the benefits of all covered persons or changes in the benefit levels, plan design or other risk factors. Any such change will be made on a class basis according to UNUM’s underwriting risk studies under this type of insurance.

Tax Treatment

Payroll deducts premiums for this insurance post tax. You may be able to deduct the cost of your premium payments from your income tax. Please see your tax advisor for information.

Dual Covered Employees