Long-Term Care Insurance
What is it?
Long-term care insurance refers to coverage for a wide range of personal care, health care and social services for people of all ages who can no longer care for themselves. Under long-term care, individuals receive assistance with normal activities of daily living, such as eating, dressing, and getting in and out of bed.
Who is eligible?
Salaried full-time or part-time faculty, salaried classified staff who work at least 20 hours per week, and retirees of the Commonwealth. Certain family members of these employees or retirees are also eligible including the employee's spouse, parents and parents-in-law, and the retiree's spouse or surviving spouse. Important: Eligible family members may enroll even if the employee or retiree decides not to participate.
Why do I need it?
Long term care insurance is different from disability insurance. Disability insurance replaces all or part of your income for certain illnesses or accidents. It doesn't cover nursing facilities or home health care expenses. Most private health insurance plans pay for doctors' visits and hospital stays but don't usually pay for home care or nursing facilities.
What is it at Mason?
There are two, separate long-term care policies offered by the Commonwealth, one is administered by Long Term Care Group, Inc. through the Virginia Retirement System (VRS) and the other is insured by Aetna Life Insurance Company through the Department of Human Resource Management (DHRM). Eligible Mason employees include full-time, salaried, classified or faculty, and part-time classified. Mason employees, their spouses, parents and parents-in-law are eligible. If you apply for this coverage within 60 days of date of hire, you are guaranteed acceptance without answering medical questions.
Those employees not participating in VSDP are eligible for the voluntary DHRM long-term care insurance program and are able to choose daily benefit amounts ranging from $50 to $200.
An automatic long-term care program is provided to full-time and part-time state employees who participate in VSDP and receive a $96 per day, employer-paid benefit.Benefit levels vary according to whether the services are performed at a nursing home, an assisted living facility, adult day care center, or at home. To receive benefits, the participant must be unable to perform substantially two of six activities of daily living or have a severe cognitive impairment. After a 90 day waiting period Aetna's long term care plan:
- Pays Actual Expenses up to 100% of the Daily Benefit Amount for care received in a licensed nursing facility, licensed hospice facility, or assisted living facility
- Pays Actual Expenses up to 50% of the Daily Benefit Amount for professional care received at home
- Pays Actual Expenses up to 50% of the Daily Benefit Amount for Adult Day Care
Premiums for long-term care insurance are based on age, the daily benefit amount chosen ($50 to $200 per day) and the number of years selected (two or five years with or without the benefit bank). The younger you are, the less you pay in semi-monthly premiums.
The "pool of money" available for expenses is the lifetime maximum of benefits. The "pool" is based on a maximum benefit of two years (730 days) or five years (1,825 days). To determine the amount of money in your "pool", you would take the number of days (730/1,825) multiplied by your selected daily benefit amount.
You will be offered the plan's inflation protection feature every two years when you can buy additional amounts of coverage without any health screening by Aetna. The increased amount available would range from a minimum of $1 per day up to 5 percent of your current daily benefit plan maximum
Special note regarding enrollment:
At the present time, the Department of Human Resource Management has no plans to offer another guaranteed acceptance special open enrollment period. Employees who are not a new hire and/or who have not enrolled during a prior special open enrollment period, and eligible family members, will be required to complete a medical questionnaire and must be approved by Aetna to be eligible for coverage. Enrollment forms can be downloaded by visiting the Aetna Web site or you may enroll by contacting Aetna toll-free at 1-877-894-2470.
For More Information ...
Please see the Department of Human Resource Management (DHRM) information on long term care insurance.
