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Faculty, Staff & Librarians - Long Term Care Insurance

CHANGE NOTICE

Long-Term Care Insurance Closing to New Applicants

Due to financial forecasts that no longer make it viable to offer long-term care (LTC) insurance, John Hancock Life Insurance Company has announced that their LTC plan through the PEBB Program will close to new applicants beginning August 1, 2014, and PEBB will no longer offer LTC insurance benefits to state employees.

To apply, request an enrollment kit from John Hancock Life Insurance by calling 800-399-7271. Make your request as soon as possible to allow time for mailing, completing, and returning the forms by the deadline.


UNDERSTAND

Long-term care (LTC) refers to a broad range of medical, personal, and social services provided to people who are unable to care for themselves over a relatively long period of time. Although most people think long-term care refers to care in a nursing home, care can also be provided at home by home health care workers, nurses, or therapists, or in a community-based adult day care center.

The vendor for the Public Employee Benefits Board (PEBB) for LTC insurance is John Hancock Mutual Life Company. Contact the company at:

Website: http://pebbltc.jhancock.com/washington/home.html
User name: pebbltc
Password: jhancock

Customer Service: 1-800-399-7271

Eligibility

You are eligible to apply for group LTC insurance if you are:

Eligible family members may apply regardless of whether the active employee or retiree applies.

Proof of Good Health

You will need to provide proof of good health if you are:

Qualification

You qualify for benefits when a licensed health care practitioner certifies that, due to a covered condition, you are dependent in at least two of six Significant Activities of Daily Living (SADLs) or you are cognitively impaired. A John Hancock patient advocate will verify this information.

SADL Dependence

You qualify for benefits when a licensed health care practitioner certifies that, due to a covered condition, you are dependent in at least two of six Significant Activities of Daily Living (SADLs) or you are cognitively impaired. A John Hancock patient advocate will verify this information.

The six SADLs are:

Coverage Options

Three coverage options are available:

Bronze Plan
This plan is the most affordable of the three options. It includes lower Daily Maximum and Lifetime Maximum Benefits.
Silver Plan
This plan has higher Daily Maximum and Lifetime Maximum Benefits than the Bronze plan.
Gold Plan
This plan includes the highest Daily Maximum and Lifetime Maximum Benefits.

Qualification Period

The Qualification Period is the period of time you must wait from the date the patient advocate verifies that you qualify for benefits until the date benefits are payable for covered charges you incur. The Qualification Period is 90 days. You must remain certified during this period but you do not have to receive long-term care services or be hospitalized. The policy will pay benefits for covered charges you incur after the qualification period is met as long as you remain certified.

Maximum Benefit

The Daily Maximum Benefit (DMB) is the most the insurance will pay for covered services received on any given day. The Lifetime Maximum Benefit (LMB) is the total pool of money payable for covered long-term care services received while you are insured.

Plan Daily Maximum Benefit (DMB) Lifetime Maximum Benefit (LMB)
Bronze $145 $158,775*
Silver $185 $337,625**
Gold $230 $419,750**

*The Bronze coverage option has an LMB which is calculated at 1,095 (the number of days in 3 years) x the Nursing Home DMB.
**The Silver and Gold coverage options have an LMB calculated at 1,825 (the number of days in 5 years) x the Nursing Home DMB.

The policy will pay benefits equal to the daily covered charges up to the percentages of the chosen DMB as shown below. The dollar amounts below provide an example of the daily benefits available for each type of care under the $145 DMB.

Type of Care % Coverage Daily Maximum Benefit (DMB)
Nursing Home 100% $145.00
Alternate Care Facility 75% $108.75
Home Care/Adult Day Health Care 60% $87.00
Informal Care* 25% $36.25

*The total benefits payable for all informal care received in any calendar year is 21 times the Informal Care DMB. (These benefits vary slightly for residents of Kansas. Call 1-800-399-7271-for details.)

Inflation Protection

Future Purchase Option - Included in your coverage is a Future Purchase Option (FPO) inflation protection provision. You may be offered additional amounts of coverage every three years to keep up with inflation. The amount of each adjustment will reflect a benefit increase of at least 5% compounded annually for the applicable period.

Automatic Benefit Increase - For an additional cost, you have the choice of replacing the FPO with an Automatic Benefit Increase (ABI) inflation protection provision. Instead of offering inflation amounts every three years at additional cost, the price is already calculated into your premium rate. Your benefit amounts will automatically increase every year at a rate of 5% of the Nursing Home DMB when in effect, while your premium remains level. No inflation will be offered under the ABI if your coverage is being continued in effect in a Reduced Paid-Up basis as described below.

Reduced Paid-Up Option

Reduced paid-up option allows you to stop making premium payments after paying premiums for at least three years. If you elect this option, you will retain a portion of the original coverage. When you exercise this benefit, you keep your full DMB amount, but the LMB is reduced.

Portability

If you retire or leave your employer, your coverage may be continued at group rates. You simply continue paying premiums directly to John Hancock.

Exclusions

To keep coverage more affordable, some exclusions apply. No benefits are payable for services received due to the following conditions and circumstances:

These exclusions may not apply in all states and may vary depending on the state in which you live. The Certificate of Insurance you receive once you are approved for coverage will outline the exact exclusions for your state. If you move to another state, the state guidelines where the Certificate of Insurance was originally delivered to you will apply.

Long-term care providers must meet the qualifications specified in the Certificate of Insurance that will be issued to you when you become approved for coverage and all services and supplies must be provided in accordance with a plan of care prescribed by a licensed health care practitioner.

Premiums

Premiums are specific to the individual. To use the rate calculator, visit John Hancock Mutual Life Company and log in using username: pebbltc and password: jhancock

You have the option of paying premiums directly to John Hancock or through automatic bank withdrawal.

ACT

Enrollment

For an individual rate packet and enrollment form, contact the John Hancock Mutual Life Company at 1-800-399-7271 or visit the website (instruction above) and complete the email form located at the "Contact Us" link.

EXPLORE

John Hancock Long-Term Care Insurance Summary
User name: pebbltc
Password: jhancock

LTC Information & Resources


Note: If there is any conflict between this enrollment brochure and the Certificate of Insurance, the terms of the Certificate will control. Please note that plan provisions may be changed or deleted in order to satisfy state requirements or other legal requirements and the Washington State Health Care Authority reserves the right to end or amend the plan for any reason. If the Washington State Health Care Authority discontinues the plan, existing insureds continue coverage through John Hancock.

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