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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 happens to my premium contributions if I were to die before the age of 74?
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 member, a full-time employee of the AICPA, or a qualified family member (spouse, adult children and their spouses, domestic partner*, parent, parent-in-law, grandparent, or grandparent-in-law). | |
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Reside in an eligible jurisdiction. | |
| *Domestic partners may not be recognized in all states. | ||
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 maximum daily benefit options are: $100, $150, $200, $250, or $300 for Nursing Home care and 100% or 60% of the Nursing Home Care Daily Maximum Benefit for Home and Community Based Care. The Lifetime maximum benefit ranges from $109,500 to $1,095,000 depending on the Daily Maximum and Benefit Period selected.
Is there protection against inflation?
You have two options to protect yourself against inflation:
| 1. | 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). | |
| 2. | Periodic Inflation Protection - allows you to purchase additional coverage for inflation protection every 3 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 5049. | ||
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 be assessed and 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:
| 1. | 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. | |
| 2. | 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 waiting period which begins on the date you are assessed by a Licensed Health Care Practitioner certifying your chronic illness or disability.
What happens to my premium contributions if I were to die before the age of 74?
Should you die before the age of 74, a portion of contributions paid for your coverage, less any benefit payments, will be returned. The percentage of contributions to be refunded is based on your age at death.
What are the Plan's Exclusions?
Plan exclusions may vary by state. Generally, benefits will not be reimbursed if the following situations apply:
Work-Connected Conditions Charge: A charge covered by a workers' compensation law, occupational disease law, or similar law.
Government Plan Charge: (Does not apply to CO residents.) A charge for a service or a supply (a) furnished by or for the United States government or any other government, unless payment of the charge is required by law; or (b) to the extent that the service or supply, or any benefit for the charge, is provided by any law of governmental plan under which the patient is or could be covered. This (b) does not apply to a state plan under Medicaid or to any law or Medicare. The benefits provided by Medicare will be deemed to include any amount that would have been payable by Medicare in the absence of a deductible or coinsurance requirement under that program.
Self-inflicted Injury or Suicide: (Does not apply to CA, CO and ID residents*.) Charges arising from intentionally self-inflicted injury or attempted suicide, which sane or suffering from inorganic-based insanity.
*For residents of CA and ID: Self-inflicted Injury or Suicide - Charges arising from intentionally self-inflicted injury or attempted suicide.
Services and Supplies Outside the United States: (Does not apply to DE residents.) Charges for services or supplies outside the United States.
Treatment for Chronic Alcoholism or Chemical Dependency: Does not apply to CO, OK**, and WA.) Charges in connection with the treatment of chronic alcoholism or chemical dependency.
** For residents of OK: Treatment for Chronic Alcoholism or Chemical Dependency - Charges in connection with the treatment of chronic alcoholism or drug addiction.
War, Felony, Riot, or Insurrection: (Does not apply to CO and OK*** residents.) Charges for a condition due to war or any act of war while you are insured or due to the insured's participation in an act of felony, riot or insurrection. War means declared or undeclared war and includes resistance to armed aggression. Riot means a wild, violent, public disturbance of the peace.
***For residents of OK: War, Felony, Riot, or Insurrection - Charges for illness, treatment or medical condition due to war or an act of war, whether declared or undeclared, while serving in the military service or any auxiliary unit attached thereto or due to your participation in an act of felony, riot or insurrection while you are insured. "Riot" means a wild, violent, public disturbance of the peace.
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, coverages, amounts, conditions and exclusions.
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