Eligibility
You are eligible to purchase long term care insurance on your first day of work if you are a full-time employee, a temporary full-time employee hired to work at least 12 months, or a part-time employee working more than 50% of a regular full-time schedule.

These eligible family members may also request enrollment:

• spouses or surviving spouses
• parents and parents-in-law
• grandparents and grandparents-in-law.

You do not have to be enrolled in the plan in order for your spouse, parents, or grandparents to participate.  This plan is also available to retirees of the Company.  Spouses or surviving spouses of retirees may also participate.

 

Enrollment
As an eligible employee, you will not have to complete a statement of health for your coverage if you enroll within 30 days of the date you are hired and you are Actively at Work (as defined in the following paragraphs) on your effective date of coverage.

If you do not enroll within 30 days of the date you are hired, you must complete a statement of health.  Eligible family members must also complete a statement of health when they request enrollment.

To obtain an enrollment package for yourself or an eligible family member, call MetLife at 1-800-GET-MET8 (1-800-438-6388).  The enrollment package will include the statement of health and a premium chart.  If you complete a statement of health and your request for enrollment is denied by MetLife, the notice of denial will include instructions on how to appeal the decision.

Actively at Work means you are employed and meet all of the following conditions:

• You  are  reporting  for work at your usual place of employment or other location  to  which  the  Group  Policyholder's business requires you to travel, or you are on vacation;

and

• You are able to perform all the usual and customary duties of your occupation on a regular full-time basis or regular part-time basis.
• You are not absent from work due to sickness, injury or medical leave of absence, long-term disability.

 

When Coverage Begins
As an eligible employee who enrolls without completing a statement of health, your coverage begins on the first day of the month after your request for enrollment has been received, as long as you are Actively at Work on that day.  If you are not Actively at Work, your coverage will begin the first of the month after you return to work

If you enroll with a statement of health, your coverage will begin the first of the month following the date MetLife accepts your request for enrollment.

If you enroll with a statement of health and you are accepted into the plan, once you are authorized for benefits and have completed the waiting period, benefit payments will begin even if you have a pre-existing condition.

 

Premium Payments
You pay the full cost of your coverage.  The cost of your coverage depends on the daily benefit and lifetime benefit you chose, and your age as of the time your coverage began.

Employees and spouses pay for their coverage by having their premiums deducted from the employee’s paycheck on an after-tax basis.  All other eligible family members will pay MetLife directly.

If you pay MetLife directly, you may be billed quarterly, semi-annually or annually, or you may have monthly deductions taken directly from your checking account.  You will have a 31-day grace period.  If you do not pay within that grace period, your coverage will be canceled as of the last day of the month in which you paid your last contributions.

… Changes in Premiums
When you enroll, your premiums will be based on your age as of the time your coverage becomes effective.  Except for changes in premium rates for all enrollees, which may occur from time to time, your premiums remain the same as you get older.  If you increase your coverage, your contributions for the additional coverage will be based on your age at the time the change is effective.

… No Premiums While Benefits are Paid
You will not be required to pay premiums during any period in which you are receiving benefits.  Premiums are waived as of the first day of the month following the date you begin receiving benefits.  Your premiums will resume as of the first of the month on or after the date your eligibility for benefits ceases.  If you die while covered by the plan, all or a portion of your premiums may be returned to your estate.

If you die before age 65, your estate will receive the contributions you paid up until the date of your death, less any benefits you had received.

If you die after age 65, your estate will receive the contributions you paid up to age 65, less any benefits you had received.  This amount will be reduced by approximately 20% each year after age 65.  There will be no return of premium if death occurs after age 70.

Note: Due to state insurance regulations this feature is not available to residents of Washington.  Residents of this state will have an enhanced transition expense benefit instead of this feature

… If You Stop Paying Premiums
If you stop paying premiums, your coverage will terminate if you have paid premiums for less than 3 years.
If you pay premiums for 3 years or more and then stop, you will still have some coverage.  The non-forfeiture feature allows you to maintain some coverage even if you choose to cancel your coverage.  The feature provides the full daily benefit with a total lifetime benefit based on the greater of the total paid contributions amount or 30 times the daily benefit in effect immediately prior to the non-forfeiture date.

 

When Benefits are Paid
Once enrolled in the plan, if you think you need benefits, you or your designated representative may call MetLife at 1-800-GET-MET8 (1-800-438-6388) to initiate the benefit authorization process.  A nurse at MetLife will review your situation with you, your doctor or other care provider to determine the extent to which you are unable to perform, without substantial assistance from another individual, the following activities of daily living:

• bathing
• dressing
• transferring (moving between a bed and a chair, for example)
• toileting
• continence
• eating.

If you are certified by a licensed health care practitioner, e.g., your doctor, or a nurse, as being unable to perform at least two of these activities of daily living for a period of 90 days, or you require substantial supervision to protect yourself from threats to your health and safety due to a severe cognitive impairment, MetLife will authorize plan benefits.

MetLife will notify you as to your authorization for benefits within ten working days after receiving the necessary information.  If you are not authorized for benefits, MetLife will explain the reasons for the denial and instruct you how to appeal the decision.

Waiting Period
Because this is long term care insurance, payments begin after you have established a need for extended care.  You must satisfy a waiting period of 90 days.  Any day paid by your group medical plan or by Medicare will count as a waiting period day.  During this waiting period, you will pay for services covered by the plan.  Once the waiting period is over, you will then begin to receive benefit payments for covered services.  You will not have to fulfill another waiting period unless you have gone for more than 180 days without being eligible for benefits.

What the Plan Pays
After you satisfy the waiting period, the plan pays benefits up to a daily benefit amount.  The daily benefit is the maximum amount of reimbursement that you can receive for each day you are eligible for benefits.  There is a daily benefit for nursing home care and respite care services and another daily benefit for home care services and assisted living facilities.  The total lifetime benefit is the maximum amount of benefits you can receive from the plan.

You choose one of three nursing home daily benefit amounts.  The nursing home daily benefit amount you choose will determine your home care daily benefit amount and your total lifetime benefit.

If you choose this nursing home daily benefit	Your home care/assisted living daily benefit will be	Your total lifetime benefit will be
$100	$ 60	$182,500
$150	$ 90	$273,750
$200	$ 120	$365,000

When the total amount of benefits you have received equals your total lifetime maximum amount, your coverage ends.

 

Coordination of Benefits
Long term care benefits will be reduced by the dollar amount payable by any of the following, to the extent that the combination of your benefit and amounts payable or amounts which would be payable by any of the following exceed 100% of the actual charge for the covered expenses:

• any federal, state or other government health care plan or law (except Medicaid or Medicare)
• any state or federal workers’ compensation law
• any employer’s liability or occupational disease law
• any motor vehicle no-fault law
• any other plan which any employer contributes to or sponsors.