Insurance Education
Part #5
Long Term Care
Insurance
(LTC)
Long Term Care
Insurance
Features
• Available
to employee, spouse,
parents and parents-in-law

Medical evidence of good health
required for spouse, parents and
parents-in-law
• To
receive benefits, subscriber
must be unable to perform certain
activities of daily living (ADLs),
varying with subscriber’s LTC plan
chosen
Insured by Aetna
Long Term Care
Insurance
(cont.)
• Examples






of ADLs
Bathing
Eating
Dressing
Transferring
Continence
Toileting
Insured by Aetna
Long Term Care
Insurance
(cont.)
• 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
Insured by Aetna
Long Term Care
Insurance
(cont.)
• Benefits
also for custodial care for
chronic, long-lasting diseases or
disabilities, including Alzheimer’s
disease
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
(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
Insured by Aetna
Long Term Care
Insurance
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
(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
Insured by Aetna
Long Term Care
Insurance
Plan Features
Disability Plan
Service Plan
Benefit 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