Summary Information Only
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.
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 -
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 18 to 84 years of age who may enroll include the
following: Your and your spouse' or domestic partner's parents and
grandparents, adult siblings and adult children
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.
initial 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
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
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.
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.
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.
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
Hired Employees – Will have 30 days from date of hire to sign up for
Guarantee Issue coverage. Coverage is effective the first of the month
following the date your Benefit Election Form is received by the agency.
Issue – As an 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. Completion of the Benefit Election
Form is required for enrollment. This does not require completion of the
Long Term Care Insurance Application (medical questionnaire) if you are
applying during your initial eligibility period.
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.
Unum Rate Estimator
Premium Rate Increases
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.
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
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.
Dual Covered Employees
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. You can
make this selection on the enrollment form. 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. Complete and submit the form to request this. Contact Unum at: (800) 227-4165, or visit their web site.