 |
HRD > Benefits Administration Services > Medical Benefits |
|
|
Long Term Care
State of Ohio employees may purchase long term care through Aetna, the state's long term care administrator. Long term care refers to a wide range of personal care, health care and social
services for people of all ages who have a chronic disease or long-lasting
disability. Long term care is sometimes referred to as custodial care and can be provided in a nursing facility, an adult day care center or at home. This insurance covers qualifying expenses that result from a loss of functional capacity, which must have occurred after the effective date of
your long term care insurance.
Each individual who enrolls for long term care coverage has their own
individual contract, resulting in individual policy flexibility. This flexibility is available at group rates and with the stability of a large group plan.
Eligibility
You may be eligible for long term care benefits if you are either a permanent full-time employee or a permanent part-time employee working 20 hours or more per week. If you are eligible for long term care, your spouse, parents, parents-in-law and adult children are also eligible. These eligible individuals may enroll for long term care even if you do not.
|
|
|
| Important Plan Features |
- Daily Benefit
Allowance. Enrollees may select a daily allowance from $60 to $300.
- Restoration
of Benefits. The lifetime maximum benefit will be restored if you
have received benefits, then recover and resume premium payments.
- Premiums do
not increase as you age. The monthly premium is based on your age
at the time you enroll.
- Inflation protection.
You will be offered opportunities to increase coverage without evidence
of insurability.
- Bed Reservation.
If hospitalized, you may use up to 21 days of benefits to reserve
a nursing home bed for your use upon hospital discharge.
- Assisted Living
Facility. This coverage provides payment at 80 percent of the daily
benefit allowance.
- Lifetime Deductible
(Waiting) Period. There is a waiting period before benefits begin.
Only one 90-day waiting period is applicable to the life of the plan.
- Federally qualified
plan. Premiums you pay for this policy will be treated as a medical
expense for the purpose of itemizing medical deductions. Premiums
may be tax deductible (see plan for details). Benefits paid by a qualified
long term care policy are not taxable income (subject to limitations).
- Premiums do
not increase with age or because you use your benefits.
|
How Do I Qualify to Receive Care?
|
This plan will provide the daily cash allowance you have selected if you
become unable to perform two of the five following activities of daily
living without substantial assistance (i.e., hands-on assistance or standby
assistance) from another person:
- Eating
- Transferring
(getting in and out of a bed, chair or wheelchair)
- Dressing
- Continence
- Toileting
This
inability to perform can be caused by an injury or an illness. The plan
also will provide benefits as a result of a severe cognitive impairment
that requires substantial supervision or verbal direction from another
person in order to protect the individual and others from serious injury.
To be determined to have suffered a qualifying loss of functional capacity,
a person must have the certification of a licensed health care practitioner
within the preceding 12-month period.
|
| How Do I Use My Long Term Care Benefits? |
1. Enroll
If you are eligible, you may initially enroll within 60 days of the date
you were hired by the state. If you enroll in this time period,
you will not have to provide proof of good health. If you do not enroll
when initially eligible, you may apply for long term care insurance anytime.
You must provide proof of good health, however, and be approved by the
insurance carrier, Aetna Life Insurance Company, to obtain coverage.
2. File a Claim
Filing a Claim: Call the toll-free Long
Term Care hotline at 1-800-537-8521 and request a Benefit Request
Form to be completed by you and an Aetna physician. In addition, an Aetna
case manager will be assigned to assist you. Case managers are registered
nurses and professional social workers who are specially trained to help
you and your relatives through the claims process.
3. Receive Long Term Care Benefits
To make things easier for you at a difficult time, we make the
benefits payment process easy. Once you qualify to receive benefits under
the plan:
- No bill is required
from a provider.
- Benefits are
paid directly to you at the end of each month, either by check or
via direct deposit to your bank account.
- Payments can
be paid directly to a provider as long as the daily benefit amount is less
than or equal to the daily charge.
|
For questions about long term care, please contact Aetna at 1-800-537-8521.
|
