Group Long-Term Care Insurance Plan

What It Is

Long-term care is the type of help people would need if they required assistance with simple, everyday activities they 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.

The NYSUT Member Benefits Trust-endored Group Long-Term Care Insurance Plan is only available for purchase by local associations, their benefit funds, and employers. The plan 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.

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

The MetLife Group 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

The NYSUT Member Benefits Trust-endored Group Long-Term Care Insurance Plan is only available for purchase by local associations, their benefit funds, and employers.

The Group Plan purchaser must cover 100% of eligible participants within the group. Since the Plan is offered on a guaranteed issue basis, no eligible group member can be excluded because of a medical condition. Retirees are not eligible under the group plan.

Features

• The plan is tax-qualified under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This means that long-term care benefits under the plan are excluded from the participant’s taxable income. In addition, there may be instances where a participant elects to “buy up” from the group plan. If premiums paid, together with unreimbursed medical expenses, exceed 7.5% of adjusted gross income, the portion of premium paid by the participant would be allowed as an itemized medical deduction.
• When benefits are first needed, an independent care manager will meet with the participant and his or her family to make informed suggestions about the right type of care and the best resources in the area.
• Each participant has only one 30-day waiting period, no matter how often benefits are collected. During the waiting period, the participant must receive and pay for qualified long-term care services.
• The total lifetime benefit is 2 years (730 days).
• Respite/Informal care allows the primary caregiver to take some time off while the participant continues to receive care.
• Coverage for hospice services is included.
• A transition expense benefit is provided if home modifications or equipment purchases are necessary to provide long-term care.
• MetLife care managers may authorize benefit payments for certain services that are not specifically defined, as long as they meet the participant’s needs and are a cost-effective alternative.
• The Plan purchaser chooses the daily benefit amounts for nursing home care: options are $100, $75 or $50. Licensed assisted living and home care coverage amounts are 50% of the nursing home daily benefit.
• Coverage is portable.
• Premiums are waived for any participant who is receiving benefits.
• MetLife will conduct meetings to explain the group plan to participants and will offer one-on-one consultations.

Plan Options

If payroll deduction of NYSUT Member Benefits Trust is available in the local association, participants may elect to “buy up” from the group plan. They must pass medical underwriting to be eligible for this option, and the premium charged for buy-up coverage is age-rated. A participant can select from a number of buy-up options including:

• increased Daily Benefit Amount.
• 3 additional years to the total lifetime benefit or an unlimited lifetime benefit duration.
• increase in the home care and assisted living benefit to 100% of the nursing home Daily Benefit Amount.
• the opportunity to increase the Daily Benefit Amount every 3 years through the optional inflation feature.

Obtain A Quote

A discounted group premium rate is determined by the age of each participant to be covered under the Plan. To obtain a Group Long-Term Care premium quote, you must provide the date of birth for each individual to be covered and the approximate potential effective date of the plan.

For more information, please contact Member Benefits toll-free at (800) 626-8101, weekdays from 9 a.m. to 5 p.m. Eastern Time.

The NYSUT Member Benefits Trust-endorsed Group Long Term Care Insurance Plan is provided and administered by Metropolitan Life Insurance Company, New York, NY (MetLife).

Implement A Plan

Once the decision has been made to purchase the NYSUT Member Benefits Trust-endorsed Long-Term Care Insurance Plan on a group basis, here’s what needs to be done to implement this plan:

• Meeting between MetLife and Group Plan purchaser is arranged to finalize plan specifics, select effective date, and review billing arrangements.
• Provide updated name, Date Of Birth, mailing address for all covered individuals.
• Provide contact name/address/phone number.
• Letter of agreement must be signed.
• Individual Certificates will be mailed to members’ home addresses.
• General membership presentation.
• Individual member meetings as needed.