Long Term Care
Frequently Asked Questions
What is Long Term Care Insurance?
Who is eligible?
Where can I receive care and what is the maximum benefit option?
Is there protection against inflation?
Will my premium contributions increase with my age?
How do I qualify for my Long Term Care Benefits?
How long do I have to wait to receive my Long Term Care benefits?
What are the Plan's Exclusions?
What is Long Term Care Insurance?
Long Term Care Insurance helps to offset the cost of long term care services received at home or in an extended care facility such as a Nursing Home or Adult Day Care facility and allows you to receive care from a professional or an informal caregiver.
Who is eligible?
You are eligible to apply if you are:
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At least age 18 and under the age of 85. | |
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An AICPA or State Society of CPA member, a full-time employee of the AICPA or of a State Society, or a full-time employee of CPA2Biz or of an eligible accounting firm. Qualified family members (spouse, adult children and their spouses, partner, parent, parent-in-law, grandparent, or grandparent-in-law) are all eligible to participate. |
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Reside in an eligible jurisdiction. |
Where can I receive care and what is the maximum benefit option?
You can receive care at a Nursing Home, your own home or at an Assisted Living facility/Residential Care facility or Adult Day Care center. The Facility Daily Benefit options are: $100, $150, $200, $250, $300 or $350 for Nursing Home care and 100% or 60% of the Facility Daily Benefit for Home Care.* The Lifetime Maximum ranges from $109,500 to $1,277,500 depending on the Facility Daily Benefit and Benefit Period selected. You may choose from among 3, 5 or 10-year benefit periods, depending on your needs.
*For participants who reside in Vermont only 100% Home Care Benefit is available.
Is there protection against inflation?
You have two options to protect yourself against inflation:
- Automatic Inflation Increase - automatically increases your Plan Benefit by 5% each year, compounded annually, while your contributions remain level based on your original issue age. Available at an additional cost. * (For Texas Residents: This mandated offer of inflation protection must be rejected before other forms of inflation protection can be offered).
- Guaranteed Purchase Option - allows you to purchase additional coverage for inflation protection every years. Coverage amounts increase at 5%, compounded annually, for each year requested. Premium contributions for this additional coverage will be based on your age and the then in force Premium rate at the time of the increase.
* For Texas Residents: Optional Auto Inflation Increase feature issued under 83500 LTC T 5198, Ed 7/2011.
Will my premium contributions increase with my age?
Your contributions will not increase because you get older, nor will they increase if your health status changes. Your contributions can increase only if you increase your coverage, or if the contributions for all covered class members are increased.
How do I qualify for my Long Term Care benefits?
In order to receive benefits, you must undergo an assessment and be certified by a Licensed Health Care Practitioner as having a chronic illness or disability. A chronic illness or disability is one in which there is either:
- The loss of ability to perform, without substantial assistance, for at least 90 days, two or more of the following six Activities of Daily Living: bathing, continence, dressing, eating, toileting, or transferring.
- A severe Cognitive Impairment, which requires substantial supervision to protect someone from threats to his/her health and safety.
A Licensed Health Care Practitioner must develop a plan of care.
How long do I have to wait to receive my Long Term Care benefits?
You are eligible for benefits after satisfying a 90-day Benefit Waiting/Elimination Period which begins on the date you are certified by a Licensed Health Care Practitioner as having a chronic illness or disability.
What are the Plan's Exclusions?
While state variations may apply to specific limitations and exclusions generally, no benefits will be payable if any of the following situations apply:
Coordination of Benefits. The benefits of this plan may be coordinated with certain other overages that provide benefits for the same services covered by this insurance. Consult your insurance certificate for more details.
Work-Connected Conditions Charge: A charge covered by a workers' compensation law, occupational disease law, or similar law.
Treatment provided in a government facility, unless payment of the charge is required by law or services provided by any law or governmental plan under which you are covered. This does not apply to a state plan under Medicaid or to any law or plan when, by law, its benefits are excess to those of any private insurance program or other non-governmental program.
Charges arising from intentionally self-inflicted injury or attempted suicide.
Charges for care or treatment provided outside the United States except as described in the International Coverage benefit.
Illness, treatment or medical conditions arising out of
a) War or an act of war, whether declared or undeclared, while you are insured*; or
b) Your participation in a felony, riot or insurrection; or
c) Alcoholism and drug addiction**.
*For Oklahoma residents: War or an act of war while serving in the military service or any auxiliary unit attached thereto; or
**For Louisiana, South Dakota and Vermont residents: Only treatment arising out of alcoholism and drug addiction is excluded.
Charges for services or supplies for which no charge would be made in the absence of insurance.
Note: These frequently asked questions are for illustrative purposes only and is not a contract. It is intended to provide a general overview of the certificate described. Please remember that only the insurance certificate can give actual terms, coverage, amounts, conditions and exclusions.
Visit Prudential's Online Information Center for:
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Coverage under the AICPA Long Term Care Plan is issued by The Prudential Insurance Company of America, 751 Broad Street, Newark, NJ 07102 (800) 732-0416. This coverage contains benefits, exclusions, limitations and eligibility requirements and specific terms and provisions under which the insurance coverage may be continued in force or discontinued. For specific costs and further details of coverage and the terms under which the policy may be continued in force or discontinued, you may call Aon Insurance Services, the Plan Administrator at (800) 223-7473. Coverage may not be available in your state. Coverage is issued under contract series 83500. For Texas Residents, Coverage is issued under 83500 BCOV 5036 Ed 7/2011. For Idaho and Oklahoma residents, coverage is issued under 83500 COV 5022 and in Pennsylvania coverage is issued under 83500 COV 5027.
Texas Residents: For Senior Counseling Service you can contact: Health Information and Counseling and Advocacy Program (HICAP), 701 W. 51st W-352, Austin, Texas 78751, Phone: 800-252-9240.
Contributions for long-term care insurance coverage are collected from participants of the American Institute of Certified Public Accountants Insurance Trust ("Trust"). The Trust remits a portion of these contributions to the American Institute of Certified Public Accountants ("AICPA") for services, meetings and other administrative costs which varies from year to year. Last year, this remittance was 0.92% of 2009 contributions.
Prudential was selected to provide long-term care insurance to AICPA members through a Request for Proposal process that considered price, plan design and customer service capability.
This is a solicitation for long term care. Insurer issued codes: California COA #1179; NAIC #68241.
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