Spotlight on Benefits: Long-term Care Insurance

Posted: August 12, 2004 at 1:00 am, Last Updated: November 30, -0001 at 12:00 am

The Commonwealth of Virginia offers long-term care insurance to eligible state employees, retirees, and certain family members through Aetna U.S. Healthcare.

Typically, people think of long-term care as nursing home care, but it actually refers to a wide range of personal care, health care, and social services for people of all ages who can no longer care for themselves. This includes hospice care, assisted living, and home health care. Under long-term care, individuals receive assistance with normal activities of daily living, such as eating, dressing, and getting in and out of bed.

While many people may require long-term care as they age, such care could also be necessary for younger individuals, for example, as a result of injuries from an automobile accident, sports activities, or other circumstances.

Those eligible for long-term care insurance under the commonwealth’s program can choose daily benefit options ranging from $50 to $200, and there are two-year and five-year plans available. Julie Kaye, benefits manager, points out that in the Washington, D.C., area, the average for nursing home care is about $7,000 per month, and the average nursing home stay is about four years. She notes that there is an advantage to opting into this program at a younger age because premiums are lower and the rate is locked in. For example, in one option, a 40-year-old selecting a $75 daily benefit would pay a premium of $70 per year, while a 50-year-old would pay about $130 per year for the same benefit.

State employees are guaranteed acceptance into the plan provided they are actively at work and apply during a specific enrollment period. Other individuals, such as spouses, parents, parents-in-law, and state retirees and their spouses may qualify for long-term care coverage, but they are required to complete an application that includes a medical questionnaire.

Benefit levels vary according to whether the services are performed at a nursing home (100 percent of the daily benefit amount), an assisted living facility (100 percent) or at home (50 percent). To receive benefits, the participant must be unable to perform substantially two of six activities of daily living or have a severe cognitive impairment. There is a waiting period of 90 days before benefits begin.

For more information, see the Department of Human Resource Management web site or contact your benefits administrator.

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