Optional UNUM Long-Term Care Insurance

Summary of Coverage

This page provides summary information only. Any error or omission here is unintentional and will be resolved in favor of plan documents or applicable federal or state law or rule.

• If you have coverage as a current employee, you may continue your coverage as a retiree and pay your premiums directly to UNUM.
  

Enrolling

Members eligible for UNUM Long-Term Care (LTC) Insurance can enroll for coverage at any time - not just during Open Enrollment.

• UNUM LTC Insurance coverage isn't available to new retirees.

Your spouse or Domestic Partner can only be enrolled in LTC Insurance with UNUM approval after submitting the Evidence of Insurability Application.

Eligibility

All PEBB-eligible employees* who are 18 to 84 years old are eligible to enroll in long-term care insurance. The following individuals within the same age range are also eligible:

• The employee's spouse or Domestic Partner
• Non-Medicare eligible retirees and retirees' spouse or Domestic Partner
  

Effective Dates

• Coverage begins on the first of the month following your enrollment and approval by UNUM.

Your initial coverage won't begin on the date that the coverage would normally begin if you're absent from work because of injury, sickness, temporary layoff or leave of absence. Coverage begins one minute after midnight on the first day of the month after you return to work.

Benefit Description

You are eligible for a monthly benefit after:

• You become disabled.
  
• You are receiving services in a long-term care facility or assisted living facility or adult foster home; or professional home care services if your plan includes a professional home care services benefit; or total home care if your plan includes a total home care benefit;
• You have satisfied your elimination period; and
• A physician has certified that you are unable to perform, without substantial assistance from another individual, two or more activities of daily living (ADLs) for a period of at least 90 days, or that you require substantial supervision by another individual to protect you and others from threats to health or safety due to severe cognitive impairment.
• You will be required to submit a physician certification every 12 months.
• A monthly benefit will become payable once all requirements are met. The treatment and services you receive for your disability must be provided pursuant to a written plan of care developed by a licensed health care practitioner.
• If you have an existing loss of ADLs or severe cognitive impairment on your effective date of coverage, that loss or impairment will only be eligible for coverage if you recover from that loss or impairment. The insurance carrier must receive acceptable proof of your ADL or cognitive recovery, such as a physician's statement or an assessment.

The amount of your monthly benefit will be based on the coverage options you chose, and the place of residence used for Long-Term Care.

• If your coverage includes professional home care services, the benefit payment will be based on the number of days you receive these services.

Total Home Care Benefit

You will receive the monthly total home care benefit amount if you are disabled and you choose to receive care anywhere other than in a long-term care facility or assisted living facility.

This care can be provided at any type of facility, such as an adult day care facility or your home. Care can be provided to you by:

• A formal caregiver, such as a licensed home health care provider, a registered nurse, a licensed practical nurse
• An informal caregiver, such as a friend or relative

Guarantee Issue

Newly Hired Employees

• Have 30 days from date of hire to sign up for Guarantee Issue coverage.

As a Newly Hired Employee you are eligible for benefit amounts on a Guarantee Issue basis of up to and including $4,000 and a Facility Benefit Duration of three or six years.

• This doesn't require completion of a Medical Questionnaire if you are applying during your initial eligibility period.

Amounts over $4,000 and Unlimited Duration requires you to complete and return the following forms (linked in the top-right of this page):

1. PEBB's LTC Enrollment and Cancellation Form - Return this form to PEBB
2. UNUM Medical Questionnaire - Return this form to UNUM

Coverage is also available to your spouse or Domestic Partner and requires a Medical Questionnaire for all coverages.

Current Employees

• Not available to current retirees
• There is no guarantee issue.

You can apply at any time, not just during Open Enrollment. Required and subject to approval, you must complete and return the following forms (linked in the top-right of this page):

1. PEBB's LTC Enrollment and Cancellation Form - Return this form to PEBB
2. UNUM Medical Questionnaire - Return this form to UNUM

Coverage is also available to your spouse or Domestic Partner and requires a Medical Questionnaire for all coverages.

Dual Covered Employees

• If you and your spouse or Domestic Partner are both PEBB eligible state or university employees and both enroll in long-term care insurance, you may choose to have the premium paid from your individual pay or from the other individual's pay.
• If one of you leaves PEBB eligible state or university employment service (through retirement, for example), PEBB can roll over the premium deduction for this coverage from the pay of the employee who is leaving to the pay of the employee who continues as an active employee.
  

Premiums

Tax Treatment

Payroll deducts Premiums for this insurance post tax. You may be able to deduct the cost of your Premium payments from your income tax.

• Please see your tax advisor for information.

Rates

You may choose from $1,000 - $6,000 in-facility monthly benefit.

• Your monthly Premium will equal the monthly rate for the plan you choose times the facility monthly benefit amount per thousand.

Rate Increases

Increasing your coverage, won't increase the premium for initial coverage. However, the premium to pay for increased coverage will go up as it will tie to your age when the increase goes into effect.

UNUM has the Right to Change Premiums:

• The rate will not increase because you grow older or because of your use of the benefits. However, the rate schedule may change in the future depending on the overall use of the benefits of all covered persons or changes in the benefit levels, plan design or other risk factors.
• Any such change will be made on a class basis according to UNUM's underwriting risk studies under this type of insurance.