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Long-Term Care Insurance

  • MedAmerica
  • The long-term care plan is offered to you by MedAmerica.  MedAmerica was selected by the State through a competitive bid process to administer this plan.
  • MedAmerica’s mission is “to provide affordable, dignified access to needed and effective long-term care services.”

What is Long-Term Care

  • Long-term care is assistance you need if you are unable to carry out the basic activities of everyday living - bathing, continence, dressing, toileting, eating, or transferring from a chair or bed. The need could arise from an accident or a debilitating illness. Or it could simply be the natural result of aging.
  • You could need long-term care at any time, at any age.  One out of two Americans will require long-term care at some time in their lives, and 40% of Americans receiving long-term care are under the age of 65.2   Also, the need for long-term care is likely to increase as life expectancy rises.

What is Long-Term Care

  • Long-term care is assistance you need if you are unable to carry out the basic activities of everyday living - bathing, continence, dressing, toileting, eating, or transferring from a chair or bed. The need could arise from an accident or a debilitating illness. Or it could simply be the natural result of aging.
  • You could need long-term care at any time, at any age.  One out of two Americans will require long-term care at some time in their lives, and 40% of Americans receiving long-term care are under the age of 65.2   Also, the need for long-term care is likely to increase as life expectancy rises.
  • Long-term care is different from the type of care you would receive in a hospital.  It is not traditional medical care. It is extended care you would receive at home, in an assisted living or nursing facility, adult day care or hospice.
  • Long-term care is extended, chronic care as a result of an accident, illness, advanced age, or a cognitive impairment like Alzheimer’s disease or Parkinson’s disease.

Who is Eligible

  • Regular full- and part-time employees regularly scheduled to work not less than 30 hours per week
  • Seasonal or part-time employees with 24 months of service and certified by an appointing authority to work at least 1,450 hours per fiscal year.
  • Family members (spouse, dependent child 18-24, parent, parent-in-law)
  • Dependent survivor

Provisions

  • You must meet the active-at-work requirement – you must on the day coverage is to begin, be at the employer’s place of business or at a location to which the employer’s business requires you to travel and be able to fully perform the duties of your position for your normal workday.  This includes any day on which you are on vacation or on authorized leave provided such absence is not due to illness or injury or leave without pay.
  • If you are on disability, you will be eligible to enroll for coverage when returning to active employment status.
  •  As a new employee, you have 90 days from your hire date to enroll in the long-term care plan.  If you do not enroll during this period and decide to enroll at a later date, coverage will only be available through medical underwriting.
  • You can enroll your spouse, parents and parents-in-law, unmarried dependent child(ren) (including adopted and step) up to age 24.  Dependents 19-24 years of age must be a full-time student or declared on your Income Tax return. 
  • These dependents will need to answer medical questions to be approved for the long-term care coverage.

Benefits

  • To collect benefits from the long-term care insurance plan, either your doctor, a registered nurse (RN), or a licensed social worker has to develop a plan of care and say that you are expected to need help with at least two Activities of Daily Living for at least 90 days or that you have a severe cognitive impairment that makes you a threat to yourself or someone else.  The 90-day expectation is there to ensure that this insurance pays for long-term care, not short-term care.
  • This plan gives you three choices:  You will need to decide how much benefit you need, $200, $150 or $100 per day for room and board in an assisted living or nursing home setting and a corresponding benefit for home care, adult day care, hospice and respite care of $120, $90 or $60.
  • Benefit period – you can select from two options – 3 years or 5 years
  • Inflation coverage – this benefit increases your daily benefit 5% compounded per year for the rest of your life, and continues to increase even while you are receiving benefits.  This coverage is optional and it increases the cost of your premium.
  • Waiver of premium – your premium stops and your daily benefit and your total pool of money less any claims paid out continues growing 5% compounded each year.
  • MedAmerica’s Personal Care Advisors may assist you in defining the Plan of Care that is required to get a claim paid and help you arrange for services.
  • Respite Care – provides temporary care up to your daily benefit up to 21 days per calendar year at home or in a facility to give your primary caregiver a rest, and there is no deductible for this benefit.
  • 90-Day Lifetime Elimination Period – MedAmerica allows you to access benefits 90 calendar days after you are certified as being eligible for benefits with no charges.  You only have to meet this waiting period once in your lifetime, as long as you accumulated it during a 365/366 day period, and it doesn’t apply to hospice or respite care benefits.
  • Alternative Care – your plan may pay for benefits outside the scope of your plan if they are medically acceptable, cost effective and agreed to by you, your health care practitioner and MedAmerica.
  • Bed Reservation – your plan will pay up to your daily benefit 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.
  • Homemaker Services – the long-term care plan home health agency benefits also covers light housework, preparing meals, doing laundry and other household tasks that don’t require a trained home health aide.
  • Premiums – because this long-term care insurance plan is being offered through the State, you, your spouse and eligible family members are eligible for group rates, including a 10% spouse discount.  You can use payroll deduction and your family members can pay monthly, quarterly, semi-annually or annually.
  • The long-term care insurance plan is guaranteed renewable, which means it can never be cancelled as long as you pay your premium, and the premium can only increase if it goes up on an entire class of people.  It starts off with a five-year guarantee.  If you leave the  University, the plan is portable and you take it with you at the same premium and same benefits.

Enrollment Packet and Questions Regarding Coverage

You can use the premium calculator on the website at MedAmerica and enroll online (employees only), or call 1-866-615-5824 and enroll with a licensed health insurance agent, or request an enrollment kit and mail in the application.

Refer to the web site at MedAmerica or call MedAmerica at 1-800-544-0327 for more detailed information.