Long-Term Care

What It Is

Note: Information on this Web site pertains to the NYSUT Member Benefits Trust-endorsed Long-Term Care Insurance Plan that meets the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If you have a pre-HIPAA Member Benefits-endorsed Long-Term Care Insurance policy, please contact the Plan Underwriter, MetLife, for information about your plan at (800) 638-0133.

Long-term care is the type of help you would need if you required assistance with simple, everyday activities you now take for granted, such as eating, bathing or dressing. The need for long-term care can occur at any age because of an unexpected accident or serious illness. Long-term care services typically aren’t covered by other types of insurance.

NYSUT Member Benefits Trust-endorsed flexible long-term care insurance plan, customized specifically for NYSUT members, offers care planning and coverage for home health care, adult day care, homemaker services, licensed assisted living facilities, nursing home care, hospice care at home or in a licensed hospice care facility, and respite care. Premiums are level, which means premiums remain the same year after year, unless you choose to increase your coverage.

In addition, a special New York State Partnership Plan is available to residents of New York State only. With this plan, you may apply for Medicaid without having to spend down your assets if your long-term care insurance benefits end. The Partnership Plan includes an automatic inflation feature.

Benefits under the NYSUT Member Benefits Trust-endorsed Long-Term Care Insurance Plan are underwritten by Metropolitan Life Insurance Company, New York, NY.

The MetLife Long-Term Care Insurance Plan is a NYSUT Member Benefits Trust (Member Benefits)-endorsed program. Member Benefits has an expense reimbursement/endorsement arrangement of 2.5% of gross quarterly premiums for this program. All such payments to Member Benefits are used solely to defray the costs of administering its various programs and, where appropriate, to enhance them. The Insurer pools the premiums of Member Benefits participants who are insured for the purposes of determining premium rates and accounting. Coverage outside of this plan may have rates and terms that are not the same as those obtainable through Member Benefits. The Insurer or Member Benefits may hold premium reserves that may be used to offset rate increases and/or fund such other expenses related to the plan as determined appropriate by Member Benefits. Member Benefits acts as your advocate; please contact Member Benefits at (800) 626-8101 if you experience a problem with any endorsed program.

Agency fee payers to NYSUT are eligible to participate in NYSUT Member Benefits Trust-endorsed programs.

Eligibility

NYSUT members and agency fee payers are eligible to apply. Members’ spouses or domestic partners, parents (and in-laws) and grandparents (and in-laws) can also apply.

To apply for the New York State Partnership Plan, you must be a resident of New York State.

Features

Note: Information on this Web site pertains to the NYSUT Member Benefits-Trust endorsed Long-Term Care Insurance Plan that meets the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If you have a pre-HIPAA Member Benefits-endorsed Long-Term Care Insurance policy, please contact the Plan Underwriter, MetLife, for information about your plan at (800) 638-0133.

To qualify for benefits, you must need assistance with 2 of 6 activities of daily living (ADLs): eating, dressing, bathing, toileting, transferring and continence. Once you’re authorized to receive benefits and have fulfilled the one-time waiting period of 30 days of covered services, the plan will continue to pay up to the Daily Benefit Amount (DBA) for covered services until you reach your Total Lifetime Benefit, unless you’ve chosen the unlimited lifetime benefit.

To get the coverage that’s right for you, you can choose among the following:

#1 - “Comprehensive” Plan or “Nursing Home” Plan. The Comprehensive Plan covers long-term care in your own home, an eligible assisted living facility or adult day care center. It also includes respite care, allowing your primary caregiver to take some time off while someone else takes care of you, and hospice care provided by a licensed agency in your home or in a facility if you become terminally ill. The Nursing Home Plan pays benefits for care in a licensed nursing home, licensed assisted living or hospice facility, but does not include any home care coverage.

#2 – Daily Benefit Amount. You can choose from 6 Daily Benefit Amounts (DBA): $75, $100, $150, $200, $250, and $300. If you choose a DBA that is more than the actual cost of your care, the difference will stay in your Total Lifetime Benefit, extending your coverage. If your care costs more than your DBA, you pay the difference out of pocket.

#3 – Total Lifetime Benefit. You can choose a 3-year, 5-year or unlimited benefit (“Benefits-for-Life”), which, when calculated with the Daily Benefit Amount (DBA) you’ve chosen, gives you the total dollar amount the plan will pay. For example, if you choose the 3-year option and $150 DBA, you’ll have 1,095 days of coverage (365 days x 3 years) with a total lifetime benefit of $164,250 (1,095 days x $150. Before choosing a total lifetime benefit, you should consider the cost of care in the area where you might receive services and your ability to supplement this care out of pocket.

#4 – Home Care/Assisted Living Reimbursement. If you selected Comprehensive Plan in Choice #1, you’ll also need to select the level of Home Care and Assisted Living coverage that best suits you. The coverage you choose at 50% or 100% of your Daily Benefit Amount (DBA) will apply to both home care and assisted living coverage. If you select Nursing Home Plan in Choice #1, you will need to select the level of Assisted Living Coverage, 50% or 100% of your DBA; Home Care coverage is not provided under the Nursing Home Plan.

#5 – Optional Nonforfeiture Feature. If you choose this option, you will receive a reduced level of benefits if you pay your premiums for 3 years and then cancel or lapse your coverage. Under Nonforfeiture coverage, your total lifetime benefit will then be the greater of the total premiums you have paid or 30 times your Daily Benefit Amount.

#6 – Automatic Inflation Protection Feature. If you select this option when you enroll, your Daily Benefit Amount will automatically increase by 5% compounded each year. If you don’t select this feature, you will be offered opportunities in the future for inflation protection, but the cost for the additional coverage will be based on your age at the time you purchase the increased amount.

Other advantages of the Member Benefits-endorsed Long-Term Care plan:

• Premiums are based on your age as of the date your application is received by the insurance company, not the date your insurance becomes effective. There is an advantage to not delaying your application – the older you are, the higher the premium will be.
• The plan is a tax-qualified long-term care insurance plan for federal tax deductions under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. If your non-reimbursable medical expenses, including part or all of your long-term care premiums, exceed 7.5% of your adjusted gross income, you may be able to deduct the cost of these premiums if you itemize deductions on your federal income tax return. This same law lets you exclude long-term care benefits from your taxable income. Note that tax-qualified plans covered under HIPAA do not pay for benefits covered by Medicare.
• No prior hospitalization is required to be eligible for benefits.
• Physical and cognitive conditions are covered, including Alzheimer’s disease.
• Inflation adjustment offerings are made every 3 years (not applicable if you choose #6 above).
• You’re also eligible for these value-added features: a transition benefit, advisory services, an alternate plan of care, premium return, waiver of premium (when you’re collecting benefits), a bed reservation benefit, and guaranteed renewal.

If you participate in the Member Benefits-endorsed Catastrophe Major Medical Plan and Member Benefits-endorsed Long-Term Care Insurance, the two plans can work together to provide valuable benefits.

The Member Benefits-endorsed long-term care plan offers you a 30-day free look. If within 30 days of receiving your insurance certificate, you’re not fully satisfied, simply return the certificate to Metropolitan Life Insurance Company. Your coverage will be canceled and any premiums you paid refunded.

Payment Options

Premium payment options include:

• monthly automatic deductions from your checking account
• direct bill on a quarterly, semi-annual or annual basis
• payroll or pension deduction of NYSUT Member Benefits Trust, if available to you. Paying your premiums through payroll/pension deduction saves you 10% on standard monthly premiums.

How To Apply

You must complete the Long-Term Care Insurance application. The plan is medically underwritten. To receive an enrollment kit (that includes sample plans and application), or for information and application to the New York State Partnership Plan, call the Plan Underwriter toll-free at (800) 638-0133.

For more information, please visit MetLife Long-Term Care.

Contact

For more information or to receive an enrollment kit (that includes sample plans), call the Plan Underwriter toll-free at (800) 638-0133.

Note: Information on this Web site pertains to the NYSUT Member Benefits Trust-endorsed Long-Term Care Insurance Plan that meets the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If you have a pre-HIPAA Member Benefits-endorsed Long-Term Care Insurance policy, please contact the Plan Underwriter, MetLife, for information about your plan at (800) 638-0133.

For more information, please visit MetLife Long-Term Care.

Benefits under the NYSUT Member Benefits Trust-endorsed Long-Term Care Insurance Plan are underwritten by Metropolitan Life Insurance Company, New York, NY.

Educational Info

The Long-Term Care Consumer’s Guide can be downloaded below (in pdf format), is available to all members and agency fee payers, and provides clear, objective information.

• Long Term Care

This guide answers such questions as “Do I really need it?” “What exactly is it?” “What should I look for in a policy?” and more.

You can request this or other Consumer's Guides by calling Member Benefits toll-free at (800) 626-8101, weekdays from 9 a.m. to 5 p.m. Eastern Time, or e-mail us at: Member Benefits.