Summary Information Only
This webpage presents 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.
Enrolling in Long Term Care Insurance
Members eligible for long term care
insurance can enroll for coverage at any time - not just during Open
Enrollment. During Open Enrollment, you can begin the enrollment process
online through your record in the benefit system; however, you
will still need to submit forms to the carrier - UNUM. If you choose,
you can enroll using only paper forms during or outside of Open
Enrollment. All the forms for enrolling in long term care insurance are
on the carrier's website, accessible using the links below.
Eligibility & Effective Dates
PEBB-eligible employees who are 18 to 84 years old are eligible to
enroll in long-term care insurance. The following individuals in the
same age range are also eligible:
- The employee's spouse or domestic partner
- Parents and grandparents of the employee or of the employee's spouse or domestic partner
- Adult siblings or adult children of the employee or the employee's spouse or domestic partner
- Non-Medicare eligible retirees and retirees' spouse or domestic partner.
Family Members may enroll only with UNUM approval of the Evidence of Insurability Application.
insurance goes into effect the first of the month following your
enrollment (if it is guarantee issue) or the first of the month
following the insurance carriers approval.
coverage will not begin if you are absent from work because of injury,
sickness, temporary lay off or leave of absence on the date that the
coverage would normally begin. Coverage begins one minute after
midnight on the first day of the month after you return to work.
Description of Benefit
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 of these 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
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
- Newly Hired Employees
have 30 days from date of hire to sign up for Guarantee Issue coverage. An
Enrollment Form is required and coverage is effective the first of the month
following the date your Enrollment Form is received by PEBB. 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 3 or 6
years. This does not require completion of a Medical Questionnaire if you
are applying during your initial eligibility period. Amounts over $4000
and Unlimited Duration require completion of a Medical Questionnaire.
Coverage is also available to your Spouse or Domestic Partner and requires a
Medical Questionnaire for all coverages.
- Guarantee Issue
is no guarantee issue and you can apply at any time, not just during Open
Enrollment. Completion of the Enrollment Form is required and will be
subject to the approval of a Medical Questionnaire, which will need to be sent
directly to UNUM. Coverage is also available to your Spouse or Domestic
Partner and requires a medical questionnaire for all coverages.
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
Unum Rate Estimator
Premium Rate Increases
Increasing your coverage, will
not 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.
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
Dual Covered Employees
If you and your spouse or partner
are both state 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 state service (through
retirement, for example), payroll 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 is remaining. Please, contact Unum or PEBB for more information.
Contact Unum at: (800) 227-4165, or visit the Unum web site.