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Long Term Care Insurance FAQs

  1. What is the difference between Professional Home Care (Plan 1) and Family Home Care (Plan 2)?
  2. What is the advantage of choosing the Family Home Care Option (Plan 2) and why does it cost more?
  3. How does UNUM know if a family member, or a professional is providing care?
  4. What is the difference between a Nursing Home Facility and an Assisted Living Facility?
  5. What does elimination period mean?
  6. Does the waiting period have to be for 90 consecutive days?
  7. Can I pay a higher premium in order to have a shorter waiting period, such as 30 days?
  8. How will I pay for this care during the elimination period?
  9. If my parents live in another state, can I enroll them in this plan?
  10. If I enroll for a $3,000 monthly benefit under Plan 1 and require professional home care services ten days per month, then what would my benefit be?
  11. If I enroll for a $3,000 monthly benefit under Plan 2 and had a family member care for me, then what would my benefit be?
  12. If I have Long Term Disability insurance, why would I need Long Term Care Insurance?
  13. Will Medicare cover long term care expenses?
  14. Will Medicaid or MediCal cover long term care expenses?
  15. May I continue coverage if I leave TSRI?
  16. How do I submit a claim?

 

1. What is the difference between Professional Home Care (Plan 1) and Family Home Care (Plan 2)?

Professional Home Care is defined as care provided in your home by licensed nursing or other professionals which include, but are not limited to, part-time and intermittent skilled nursing services, home health aid services, physical therapy, occupational therapy, speech or audioligy services and medical social services by a social worker.

Family Home Care is defined as informal care provided in your home by a family member, friend, neighbor, or acquaintance, who is not a licensed professional.

2. What is the advantage of choosing the Family Home Care Option (Plan 2) and why does it cost more?

Plan 2 provides you with more flexibility. You can choose to have a family member, friend or neighbor provide your care.

3. How does UNUM know if a family member, or a professional is providing care?

Upon filing a claim for benefits UNUM will request certification from your physician as to your inability to perform two or more Activities of Daily Living, or that you suffer from severe cognitive impairment. Your physician also will be required to provide a Plan of Care. The Plan of Care is written documentation outlining the methods, treatments and processes that will be used to treat you while receiving Long Term Care benefits, including who will be providing care and how often it will be provided.

4. What is the difference between a Nursing Home Facility and an Assisted Living Facility?

A Nursing Home facility is an institution or distinctly separate part of a hospital that provides skilled nursing care under state licensing and certification laws.

An Assisted Living Facility provides 24 hour per day custodial care and personal services for a minimum of 10 patients in one location. It is not an individual residence or boarding home.

5. What does elimination period mean?

Elimination period is defined as a waiting period. The TSRI plan has a 90-day waiting period before benefits begin. For example, if you were continuously unable to perform two Activities of Daily Living on June 1st, your waiting period would begin on June 1st and end 90 days later. You would be eligible to receive benefits on day 91, or August 30th.

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6. Does the waiting period have to be for 90 consecutive days?

Yes.

7. Can I pay a higher premium in order to have a shorter waiting period, such as 30 days?

No, you would have to purchase an individual policy.

8. How will I pay for this care during the elimination period?

You will have to pay Long Term Care expenses out of existing savings or assets.

9. If my parents live in another state, can I enroll them in this plan?

Yes, however they must reside in the United States.

10. If I enroll for a $3,000 monthly benefit under Plan 1 and require professional home care services ten days per month, then what would my benefit be?

Your benefit would be calculated as follows: $3,000 monthly benefit divided by 30 days = $100/day. 75% of $100/day = 75.00/day x 10 days = $750 monthly benefit.

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11. If I enroll for a $3,000 monthly benefit under Plan 2 and had a family member care for me, then what would my benefit be?

Your benefit would be calculated as follows: $3,000 monthly benefit divided by 30 days = $100/day. 75% of $100/day = 75.00/day x 30 days = $2,250 monthly benefit.

12. If I have Long Term Disability insurance, why would I need Long Term Care Insurance?

Long Term Disability insurance would replace a portion of your INCOME should you become disabled. Long Term Disability insurance is typically paid for the duration of disability until age 65.

Long Term Care insurance provides a benefit to help pay for skilled nursing or home care services so you do not have to spend down your life savings or other assets.

13. Will Medicare cover long term care expenses?

No. Medicare only covers medical expenses and provides limited benefits for skilled nursing or home care services. It does not cover custodial care.

14. Will Medicaid or MediCal cover long term care expenses?

Medicaid requires a substantial depletion of assets and many facilities will not accept Medicaid patients.

15. May I continue coverage if I leave TSRI?

Yes. Within 31 days of your last day of employment, you may convert your coverage to a direct bill basis at the same rate you paid while you were employed.

16. How do I submit a claim?

1. Obtain a claim form from TSRI Benefits Administration.
2. Mail the Notice of Claim form to UNUM.
3. Complete the initial Long Term Care claim form with documentation of care
received completed by your provider.

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