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Frequently Asked Questions (FAQ's) About the Group Long-Term Care Plan
Index
1. Care & Coverage Under the Group Long-Term Care Plan for Hewlett-Packard
- long-term care general information
- the Group Long-Term Care Plan & other coverage plans
- benefit coverage & payment
- eligibility for benefits
- Group Long-Term Care Plan assessments & care advisors
2. Eligibility & Enrollment Information
4. Consumer Price Index (CPI) Increase
5. Change of Policyholder's Status
6. About Long Term Care Group, Inc.
7. The Group Long-Term Care Plan: Structure, Security & Stability
Care
& Coverage Under the Group Long-Term Care Plan
1a. Long-Term Care General Information
What exactly is long-term care?
Long-term care means services that are provided in a setting other than an acute care unit of a Hospital. In the Group Long-Term Care Plan, "long-term care" includes Skilled Nursing Care, Intermediate Care, Custodial Care, Nursing Facility Care, Alternate Facility Care, Home Care, Home Health Care, Adult Day Care, and Respite Care.
What is the current average cost for nursing homes?
The national average cost for a nursing home stay is over $45,000 per year.
What is the average stay in a nursing facility?
The average length of nursing home stay is 2 1/2 years. At today's national average per day cost, the average nursing home stay (2 1/2 years) would cost $112,500.
How do rates for the nursing care facilities in the San Francisco bay area compare to the national average?
Nursing home rates in the San Francisco area average $149 per day versus the national average of $130 per day.
1b. The HP Plan and Other Coverage Plans
What makes the Group Long-Term Care Plan better than others?
As a self-insured plan, it is subject to federal regulations and not individual state laws. Therefore, the Plan can offer the same level of benefits nationwide.
In addition, as a self-insured plan there are no insurance premium taxes or broker commissions. Therefore, more of your premiums go towards paying claims.
How do the premiums for this plan compare to one that I can buy independently?
We believe rates for the Group Long-Term Care Plan will be lower than insured long-term care benefit products with comparable benefits and plan maximums available on the open market.
Doesn't my health plan (Medicare or Medicaid) provide this kind of coverage?
Very few long-term care services are covered by the HP medical plan or many HMO plans. Typically, the medical plans cover acute care services and not custodial care services which are covered by the Group Long-Term Care Plan.
How does the Group Long-Term Care Plan complement Medicare?
Medicare covers very little of your chronic or long-term care services. Nationwide, Medicare covers only 2% of all chronic or long-term care services. Medicaid programs will cover a larger percentage of these services, but only after you have exhausted your own assets.
Is the "California Partnership" available through the Group Long-Term Care Plan?
No. The California Partnership is not offered through the Group Long-Term Care Plan.
Can I receive long-term care benefits if I have another long-term care policy?
Yes, however, the Plan will not pay benefits which duplicate benefit payments from other long-term care insurance coverage.
1c. Benefit Coverage & Payment
What are examples of mental and nervous conditions that are not organic and therefore not covered?
Mental or Nervous Condition Without an Organic Cause means: (a) neurosis; (b) psychoneurosis; (c) psychopathy; (d) psychosis; or (e) a mental or nervous disorder without demonstrable organic disease. It does not mean senility or Alzheimer's disease.
The phrase "mental disorders" will be deemed to mean "Mental or Nervous Condition Without an Organic Cause."
Is there a deductible before benefits are paid like there is for my health plan?
No. There is no deductible to be paid as there is under your medical plan. There is however a 90 day wait period which needs to be satisfied before benefits are paid.
Many of the services which are provided during the 90 day wait period are covered by other health or acute care plans.
Who pays for the cost of the care during the 90 day wait period?
You are responsible for the cost of care during the 90 day wait period. Other medical insurance you have may cover many of the expenses which you would incur in the first 90 days of a long-term care episode.
The Care Advisor will assist you in reviewing your other coverages in an attempt to assist you in maximizing benefits which may be available to you.
What is the "maximum monthly benefit"?
The "maximum monthly benefit" means the maximum benefit allowed for any combination of home care, home health care, and adult day care. It varies by level of benefit selected.
LIFETIME MAXIMUM
$100,000 $250,000 Unlimited $1,200/month $1,800/month $2,400/month
If a lower-cost level of care is recommended, and I would prefer a higher-priced level of care, can I use the higher-priced level of care and pay the difference myself?
Yes. The Care Advisor will recommend a quality service provider in your area. You are entitled to utilize the provider of your choice. You will be reimbursed the amount charged up to the Plan maximum. You will be required to pay any additional amounts over and above the Plan allowable.
Are the benefits paid directly to the provider, or is the policyholder reimbursed?
Benefits can be made payable to you or to the provider of service.
If I take a leave-of-absence from HP & continue to pay my premiums, am I still covered?
Yes.
If I leave HP and move out of the U.S., can I still receive benefits?
Under the Group Long-Term Care Plan, benefits are payable for services rendered in the United States or Canada. If you should leave HP and move overseas, you would only be eligible for coverage if you return to the U.S. or Canada for services.
If I retire overseas & need long-term care, would I be covered if I returned to the United States to receive it?
Yes. By returning to the U.S. to receive services, these services are eligible for payment under the conditions of the Group Long-Term Care Plan.
1e. Group Long-Term Care Plan Assessments & Care Advisors
In the Plan Summary there's a definition of a "Care Advisory Benefit" which covers payment for services of a Care Advisor. Under what circumstances would such a service be required?
Under the Group Long-Term Care Plan, the services of the Care Advisor are required for all cases.
What will the Care Advisor do for me?
The Care Advisor, working in conjunction with you, your family and your doctor, will develop a Plan of Care. In addition, the Care Advisor will assist you in accessing quality providers in your community.
What are considered to be "Activities of Daily Living" (ADL)?
Activities of Daily Living means certain basic daily tasks necessary to maintain a person's health and safety. A person will be considered able to perform Activities of Daily Living if he or she does not require the physical assistance of another person to do the activities.
In this Group Long-Term Care Plan, "Activities of Daily Living" refers to the activities described below:
- Bathing means the ability to wash oneself completely in a tub, a shower or by sponge bath; with or without the aid of equipment.
- Eating means the ability to consume food that has already been prepared and made available; with or without the use of adaptive utensils. "Eating" does not mean an ability or inability to prepare food.
- Dressing means the ability to: (a) put on and take off all garments and/or any braces or artificial limbs; and (b) secure and unfasten the garments or devices.
- Toileting means the ability to do all of the following, with or without the aid of equipment: (a) get to and from the toilet; (b) get on and off the toilet; and (c) maintain a reasonable level of personal hygiene for the body.
- Transferring means the ability to move in and out of a chair (including a wheelchair) or bed. If a person can move with the help of equipment such as a cane, walker, crutches, grab bars or other support devices, then he or she will be considered able to transfer positions.
What criteria is used to determine if someone is capable of performing an ADL or not?
The Care Advisor will visit you in your home and assess your ability to remain independent and at home. In addition to the in-home assessment, the Care Advisor will consult with your family and doctor.
Who determines when a person can no longer do two of the things required to be eligible for long-term care? Is my Care Advisor my medical doctor or Long Term Care Group?
The Care Advisor makes the determination of whether you can perform the Activities of Daily Living. The Care Advisor will conduct a face to face interview with you in your home and consult with your medical doctor and your family.
The Care Advisor is not your medical doctor nor an employee of Long Term Care Group or the HP Group Long-Term Care Plan. The Care Advisor is a third party who has contracted with Long Term Care Group.
Does the family of a policyholder have an input in the type of care or the facility required?
Yes, however, the final decision rests with the Care Advisor. After meeting with you in your home, consulting with your family and doctor, the Care Advisor will develop a Plan of Care.
Who has the ultimate decision making authority for choosing the care facility?
You do. The Care Advisor develops your Plan of Care. The Care Advisor is familiar with care facilities in your local area and will offer you recommendations.
If you do not agree with the type of care facility which is in the Plan of Care developed for you, you have the right to appeal under the terms of the Plan.
If in-home care has been advised but the patient or the patient's family would prefer a nursing home, to whom can I appeal this decision...HP or Long Term Care Group?
If you do not agree with the decision of the Care Advisor, you may appeal to Long Term Care Group, Group Long-Term Care Appeals Department.
What are the qualifications of the Care Advisors?
The Care Advisors are Registered Nurses (RN) or Licensed Clinical Social Workers (LCSW) with geriatric and chronic care experience.
The Care Advisors are located in your local community and are familiar with the quality providers of chronic and long-term care services in your area.
What rules do Care Advisors follow?
The Care Advisor follows the rules of the Group Long-Term Care Plan.
What governs the decisions of the Plan Administrator?
The terms of the Group Long-Term Care Plan govern the decisions of the Plan Administrator.
Eligibility
& Enrollment Information
If an HP employee doesn't enroll personally in the Group Long-Term Care Plan, can his or her spouse, parents, grandparents or in-laws still enroll?
Yes. An HP employee or retiree may elect to enroll a spouse, parents, grandparents or in-laws without enrolling him or herself.
Can an HP employee who is on Leave of Absence (either personal or medical) enroll?
No. They can enroll when they return to active status.
Are step-parents eligible to enroll?
Yes, step-parents of HP employees currently on active status, retirees and their spouses are eligible to enroll for coverage under the Group Long-Term Care Plan.
Would a person who is currently living in a nursing home be eligible for coverage?
No. A person currently living in a nursing home or receiving other chronic or long-term care services would not be eligible for coverage.
However, having been in a nursing home or having received chronic or long-term care services in the past would not necessarily exclude someone from being approved for coverage.
Is the Group Long-Term Care Plan currently being made available to the children of HP employees or retirees?
No. At this time, children are not eligible to be covered by the Group Long-Term Care Plan.
If a person is eligible for enrollment, but lives overseas, are they still eligible?
The benefits shown in the Schedule of Benefits will be paid without regard to the actual charges for the services received if:
- you are covered under this Group Long-Term Care Plan as an Employee of the Company; and
- you are living and working outside the United States because of your employment with the Company when you receive Long-Term Care.
This means that the Plan provision which limits the benefits payable to the lesser of the amount shown in the Schedule of Benefits or the actual charge for the service is waived. This provision does not change any other limit or condition of the Plan.
Do I need to have a physical or complete a medical questionnaire?
Employees who enroll within 30 days of their hire date are not required to complete a health questionnaire. Employees who enroll 30 days or more after their hire date and all other applicants are required to complete a health questionnaire.
Can I be denied coverage?
Yes, unless you are an employee who enrolls within 30 days of his or her hire date.
Can my spouse enroll at any time or is there an annual enrollment period?
Spouses and all other applicants may enroll at anytime. There is no "open enrollment period" for the Group Long-Term Care Plan.
If husband & wife are both HP employees, should they complete two applications or one?
Each applicant should complete an "employee" application.
Regardless of status or category of applicant, separate applications should be completed by each person applying for coverage.
What is considered "retired?" Is it when I cease working after a certain age? What happens if I "retire" at 50 years old? Would you consider me to be an ex-employee or a retiree?
"Retiree" means a HP Employee who has retired from the Company based on:
- 55 years of age with 15 years of full-time equivalent service; or
- an HP Enhanced Early Retirement Program (EER).
Premiums
& Upgrades
3a. Rate Variations & Inflation
Are the rates affected due to the area in which someone lives?
No. The rates are determined by your age at the time of enrollment. Where you live does not impact the rates you pay.
Is there a difference between policy benefits and policy premiums in different states?
No. The rates and policy benefits for the Group Long-Term Care Plan are the same in every state.
Will my premium payments ever increase?
Your premiums may increase, however the increase will not be as a direct result of your personal experience. The only way your rate would increase is if the rates for the entire plan are increased. Your increase would be at the same amount as the other policy holders in your age group.
Is there a cap on the amount that the premiums can increase?
No, there is no cap in the amount premiums can increase. However, rates have been set so that we expect any experience increases to be nominal.
If and when payments go up across-the-board, do payments increase by the same percentage for all participants?
Yes, this is correct.
Section IV of the Plan Summary says that the premiums can be changed at most once per year due to The Plan's experience with claim levels. How often do you expect such a change to be a reduction & how often do you expect such a change to be an increase? In either case, is there a percentage cap for changes?
The Plans were designed and rates set in the hope that they will not have to be reduced or increased. However, should a reduction or an increase be required, we would expect it to be nominal. There is no cap on the amount the rates can increase.
Can applicants purchase "inflation protection"?
Yes, every three years policyholders will have the opportunity to increase their Plan maximum benefit amounts through the Benefit Increase Option.
When this Benefit Increase Option ("inflation protection") is offered, am I required to take the option? If I choose not to take it, will it be offered to me again?
If you elect not to take the option the first time it is offered to you, you will still be offered the opportunity to take it the next time it is offered. However, should you decline the option the second time it is offered to you, it will not be offered to you again in the future.
What is the expected amount of increase to be offered through the Benefit Increase Option?
The increase will be tied to the three year increase in the Consumer Price Index and is estimated to be about 5% per year.
Are my premiums tax deductible?
We do not believe premiums are deductible for federal income tax purposes at this time.
Many states have made these premiums tax deductible on state income tax returns.
Can money be taken out of a flexible spending account to pay my Group Long-Term Care Plan premiums?
No.
What methods can be used for payment of premiums?
Employees must have their premiums and the premiums of their spouses paid via payroll deduction.
Other Plan participants can elect to have their premiums paid via automatic electronic funds transfer (EFT) or via check.
3d. Benefit Upgrades & Eligibility
If I have less than the "Unlimited Coverage," can I upgrade my policy?
Yes. You have the opportunity to upgrade your level of coverage. At the time you apply to increase your level of coverage, you will have to complete a medical questionnaire. If approved, you will be allowed to take the increase. If you are denied, you do not lose your existing coverage.
If I decide to increase my coverage, what is the age that the new premium would be based on? Would it be my age when I originally enrolled, or my age at the time that I upgraded?
The incremental difference is based on your age at the time you increase coverage. The base rate at your original time of enrollment remains the same. The resulting blended rate is your new premium.
If I develop a serious long-term illness, or become terminally ill, would I still be eligible to increase my benefits?
If your questionnaire does not establish evidence of good health, you will not be eligible to upgrade your level of coverage.
Can I upgrade my level of coverage whilst receiving benefits?
If you are receiving chronic care or long-term care services, you will not be eligible to upgrade your level of coverage.
Consumer
Price Index (CPI) Increase
How was the Consumer Price Index (CPI) amount determined?
The CPI is based on the amount of the increase on the Consumer Price Index (CPI) over the last three years.
Is the CPI-based increase applied to all plan maximums?
It is applied to all maximums that have a dollar value. It is not applied to days or months. For example, the annual 14 day respite care maximum does not increase but the dollar amount paid per day is increased. The recent information you received from Long Term Care Group, Inc. contains a description of your current and CPI-based benefit levels.
If I don't take advantage of the CPI-based increase offer (Benefit Increase Option) at this time, will I have another opportunity?
Yes, this option will be offered every three years. The next opportunity to increase your coverage will be offered in 2004. If you decline two of the CPI-based offers during the life of your enrollment in the Group Long-Term Care Plan, this option will not be offered to you again.
What is the deadline for applying for the CPI-based increase?
You will be notified of the deadline when the next offering is made.
Will I need to fill out a health questionnaire to the get the CPI-based increase (Benefit Increase Option)?
No. You do not need to complete a health questionnaire to get this increase.
I am currently receiving long-term care benefits. Can I still sign up for this option?
Yes. You can elect the CPI-based (Benefit Increase Option) increase even if you are currently receiving benefits. You will not have to pay premiums while receiving benefits; however, once you are no longer receiving benefits, your monthly premium will reflect the increase.
What happens to my current coverage and premiums if I do not elect the CPI-based increase (Benefit Increase Option)?
Nothing. There will be no change to your coverage levels or premium.
Rather than electing the CPI-based increase (Benefit Increase Option), can I increase my maximum plan coverage from the $100,000 plan to the $250,000 or to the Unlimited plan?
Yes, three years after your current coverage becomes effective, you can purchase another level of coverage. For example, if you now have the $100,000 maximum plan, you can purchase the $250,000 maximum plan or the Unlimited plan.
You will be required to complete a health questionnaire and Long Term Care Group will apply the same medical underwriting process as if you were a new enrollee.
To get an application or have additional questions answered, call Long Term Care Group at 1-888-285-7928. You can apply for increased coverage any time after you have reached the three year anniversary of your coverage effective date.
If I choose to purchase the $250,000 plan, how much will my premiums increase over what I am paying for my current $100,000 plan?
Your new premium will be based on your age on the date your new coverage is effective and the value of the coverage increase. This amount will be added to your current premium. Your new premium will not be more than a new enrollee would pay at the same age and coverage level.
Can I decrease my coverage?
Yes, after one year from your coverage effective date you can change to a plan option that represents a decrease in coverage. You will not be required to complete a health questionnaire. Your premiums for the reduced coverage will be based on your age at your original coverage effective date.
Change
of Policyholder's Status
Can I remain in the Group Long-Term Care Plan if I leave the employment of HP?
Yes. You will be able to continue your coverage even if you leave HP.
Do my premiums increase if I leave HP?
Your premiums may be higher under the "Continuation of Coverage" Plan than the Premium originally required for this coverage.
If I continue coverage after leaving HP, am I still eligible for the Benefit Increase Option or an increase in my levels of coverage?
Yes, both options would be available to you.
Under the "Continuation of Coverage" plan, what age would the premium be based on? My age at my original enrollment, or at employment termination?
Under the "Continuation of Coverage" plan, your premium would be based on your age at your initial enrollment.
Who is funding the "Continuation of Coverage" plan?
The "Continuation of Coverage" plan is funded by policyholder's premiums.
Can my coverage be canceled in any way?
Yes, your coverage may be canceled as the result of failure to pay the required premiums, material misrepresentations on your application for coverage and termination of the Long-Term Care Plan.
If I cancel my policy, do I leave with any equity? Can I get any of my premiums back?
No. The Group Long-Term Care Plan has been designed similar to a Term Life Insurance policy. If you discontinue your contributions into the Plan, you will not be eligible for benefits nor a return of premium.
If I've been in the HP Plan with "Unlimited Coverage" for ten years, I'll have paid out $5,280 in premiums. If HP terminates "The Plan" then, what will happen to the $5,280 in premiums that I would have paid?
It is HP's intent to continue operating the Group Long-Term Care Plan. In the unlikely event that HP should terminate the Plan, different options would be considered. Among the options which would be considered would be to convert existing coverage to a fully insured plan or transfer coverage to another self-funded plan.
5c. In the Event of the Policyholder’s Death
If I terminate my policy, or if I die, how is my spouse's and/or relative's policy impacted?
There is no impact on your spouse's or relative's policy in the event of the policyholder's death.
If I pre-decease my spouse or other relatives that have policies with the HP Plan, how are their policies affected?
Your relatives treatment or coverage under the Group Long-Term Care Plan would not be impacted by your death.
About
Long Term Care Group, Inc.
Where is the company based?
Long Term Care Group, Inc. is headquartered in El Segundo, CA. and has operations in Eden Prairie, MN; Hudson, WI; Orlando, Fl; and Natick, Ma.
How long has Long Term Care Group, Inc. been in business?
The company has been in business since 1990 and is the largest LTC third party administrator in the country. LTCG is committed to customer service and employs state-of-the-art technology throughout the company.
Is Long Term Care Group, Inc. rated by A.M. Best or another rating service?
Long Term Care Group, Inc. is not an insurance company, and therefore, is not rated by A.M. Best.
Is Long Term Care Group, Inc. the actual insurer? If so, what happens if they become bankrupt, merge, or are bought?
The HP Long-Term Care Plan is self-insured, meaning that the benefits of the plan will be paid from a trust fund. There is no insurance company involved. Hewlett-Packard has contracted LTCG as the plan administrator.
What other companies are Long Term Care Group, Inc. providing this service to?
Long Term Care Group, Inc. provides administration services for over 20 major insurance companies and the State of California Public Employees’ Retirement System.
What other programs or plans do Long Term Care Group offer?
Long Term Care Group designs, markets and administers individual and group long-term care programs including total care management and quality assurance.
The
Group Long-Term Care Plan: Structure, Security and Stability
What are the roles of HP and Long Term Care Group, Inc. in the Group Long-Term Care Plan?
HP is the Plan Sponsor. Long Term Care Group is the Plan administrator.
How is the Group Long-Term Care Plan funded?
The Group Long-Term Care Plan is self-funded. All premiums are transferred to a trust fund for the Group Long-Term Care Plan. Trust fund assets will be used for paying: (a) administrative expenses; (b) Group Long-Term Care benefits on a self-funded basis up to a maximum amount per person; and (c) stop loss insurance premiums to provide benefits to the trust on an insured basis over a maximum amount per person.
Who manages the Group Long-Term Care trust fund?
The operation of the trust fund is based on a trust agreement between HP and the Boston Safe Deposit and Trust Company.
What happens if Long Term Care Group goes bankrupt or is sold?
HP would select another company to administer the Group Long-Term Care Plan.
What happens if HP decides to terminate the Group Long-Term Care Plan?
In the event that HP decides to terminate the Group Long-Term Care Plan, possible alternatives may include converting to policies offered by an insurance company that provides long-term care insurance, or transferring assets to a successor self-funded plan.