This insurance covers certain services required by individuals who are no longer able to care for themselves without the assistance of others. Natural aging, a serious illness or an accident may bring on this need. Services covered include nursing home care, assisted living, home health care, home care and adult day care. Benefits are available through different options based on a daily benefit amount ($100, $150 or $200) for either a three-year or five-year coverage period. The benefits are also available with or without inflation protection.
In addition to these choices, there are a number of fixed features. There is a 90-day period that must be met — much like a deductible — by having a person qualify for services before the insurance coverage begins to pay for those services. The plan covers respite care, providing care for up to 21 days per calendar year at home or in a facility to give the primary caregiver a rest. Bed reservation is also covered 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. The plan also covers home health agency services for household tasks that do not require a trained home health aide.
The plan is guaranteed renewable, which means it can never be canceled as long as you pay your premium. The coverage is portable, so you may continue to pay premiums directly to the insurance company under the same terms and conditions as active employees if you leave employment. The plan includes a waiver of premium so that if you qualify for benefits and satisfy the 90-day period, you can stop payment of premium and the coverage will remain in effect.
State and higher education members are eligible to apply for optional long-term care coverage at any time. Effective January 1, 2012, this coverage will also be available to local education and local government employees (if offered by your agency). Local education and local government retirees are also eligible for coverage regardless of whether or not your former employing agency chooses to participate.
New state and higher education employees have 90 days to enroll and have guaranteed issue of coverage. Employees may sign-up for coverage by completing the enrollment form enclosed in the enrollment kit, over the phone by speaking with a customer service representative at MedAmerica Insurance Company or on-line via the website at www.ltc-tn.com. The employee's spouse, eligible dependent children, parents and parents-in-law may also apply for coverage; however, they must provide information about their health status. After the initial guaranteed issue period, employees may still apply for coverage, but will be subject to the same medical underwriting review for approval to participate.
For local education and local government employees, when your agency first chooses to offer this benefit, you can enroll in coverage on a guaranteed issue basis (no medical underwriting) during the initial offering period. Eligible family members and retirees may apply; however, enrollment is subject to medical underwriting review for approval. Call MedAmerica or refer to their website to obtain enrollment information. Contact your agency benefits coordinator to find out if this benefit is available to you and to determine if any premium support is provided.
The premiums for long-term care insurance are based on your age at the time of enrollment. Therefore, the younger you are when you apply, the lower your monthly premium will be. You may choose to have the premium taken from your payroll check, or may opt for a direct bill arrangement with MedAmerica. Direct billing or payment by bank draft or credit card can be set up on a quarterly, semi-annual or annual basis. Please see the Long-Term Care Premium Page for a complete list of premiums. Long-term care overview in PDF format.