Embed Size (px)
DESCRIPTION
Group Long-Term Care. Category Page Long Term-Care Services / Definitions 3-5 Plan Highlights / Description of Benefits 6-18 New York Partnership Plan 19-20 Portability 21 Qualifying for Benefits 22 Eligibility / Who Can Enroll 23-25 - PowerPoint PPT Presentation
Citation preview
Group Long-Term Care
CNA Long-Term CareContents Overview
Category Page
Long Term-Care Services / Definitions 3-5 Plan Highlights / Description of Benefits 6-18 New York Partnership Plan 19-20 Portability 21 Qualifying for Benefits 22 Eligibility / Who Can Enroll 23-25 Premium 26-28 Administration 29-34 Claims 35-36 Contacts / Customer Service 37-39
3
What is Long-Term Care?
Long-Term Care is a variety of services available to individuals who are unable to care for themselves
Services can be provided on a temporary or permanent basis
Services can range from simple help with meal preparation, to assistance with dressing or bathing, to complete 24 - hour monitored care
4
Where are Long-Term Care Services Provided?
Institutions • Nursing Home Facility• Alternate Care Facility• Hospice Care Facility
Community-Based Services• Home Health Care• Adult Day Care / Adult Foster Care• Home Hospice Care• Assisted Living Facilities
5
Assisted Living Facility
Eligible expenses for needed services that exceed standard charges for basic housing
Home-like environment, i.e. apartment complex or residential community
Insured allowed to make decisions and have control over life
Facility provides a combination of housing, personal support services and health care
Paid at community-based care benefit level
6
The Research Foundation Plan Highlights
Daily Nursing Home BenefitsCommunity-Based Care BenefitLifetime Maximum BenefitCaregiver Training Benefit
Temporary Bed Holding Benefit
Emergency Alert Benefit
Care Assist Benefit
7
The Research Foundation Plan Highlights
Inflation Protection Standard
Guaranteed Benefit Increase Optional
Lifetime Automatic Benefit Increase
Waiting Period
Waiver of Premium
8
Daily Benefit Amounts
Daily Nursing Home Benefit $100, $150, $180, $250
Community-Based Care Benefit 60% of daily nursing home benefit selected $60, $90, $108, $150
9
Lifetime Maximum Benefit
Pool of available funds for eligible long-term care expenses
Based on the daily nursing home benefit selected and Lifetime Maximum Option chosen
Three Options Available 1095 times the daily nursing home benefit(3 year) 1825 times the daily nursing home benefit(5 year) 5000 times the daily nursing home benefit(13.5 year)
10
Lifetime Maximum Benefit
1095X (3 year) Lifetime Maximum$100 = $109,500 $180 = $197,100$150 = $164,250 $250 = $273,750
1825X (5 year) Lifetime Maximum$100 = $182,500 $180 = $328,500$150 = $273,750 $250 = $456,250
5000X (13.5 year) Lifetime Maximum$100 = $500,000 $180 = $900,000$150 = $750,000 $250 = $1,250,000
11
Caregiver Training Benefit
Training for an informal caregiver to provide care for insured
Pays actual cost up to 3 times the community-based care daily benefit amount:
Example: $60 x 3 = $180
12
Temporary Bed Holding
Pays up to the daily nursing home benefit for fees charged by a nursing home when insured leaves due to a temporary absence (i.e., hospitalization) The payment is required by the nursing home Benefits available up to 21 days per year
Example: $100 x 21 = $2,100
13
Emergency Alert
Pays for the rental of home emergency alert system
Reimburses actual monthly cost up to community-based care daily benefit:
Example: $60/month
14
Care Assist Benefit
Provides benefits to allow informal caregiver the opportunity to take time away from responsibilities No waiting period applies Daily maximum is available up to 21 days per
year Another informal caregiver may assist in the
care of the insured
15
Waiting Period &Waiver of Premium
Waiting Period 90 calendar days following the date claimant is
certified as chronically ill by Licensed Health Care Practitioner
Waiver of Premium Waives premiums which become due while
receiving benefits Begins after completion of the 90 day waiting
period If long term care services are no longer required,
premiums will be waived for an additional 6 months
16
Inflation Protection
Guaranteed Benefit Increase Opportunity to purchase additional amounts of
coverage Timing of offers determined by The Research
Foundation and CNA Additional coverage guaranteed issue (GI) during
“buy-up” periods only Premium for additional benefit amount based on
age when purchased Premium for original benefit amount is not affected
17
Inflation ProtectionExample:
6/1/2003 — Age at entry = 40 Purchased 5 year(1825x) plan with $100 daily benefit
Bi-weekly premium = $6.346/1/2006 — Now 43 years old - Accepts CNA offer to
purchase additional coverage of $20. Bi-weekly cost for additional $20 = $1.52
New daily benefit = $120 New Bi-weekly premium = $7.86 Note - Premium lower than someone just entering plan with
same age and daily benefit amount (ex: New participant Age 43 Daily Benefit - $120 Bi-weekly Prem. $9.11)
18
Inflation Protection
Optional Benefit Lifetime Automatic Benefit Increase All benefit amounts will automatically increase on
each anniversary date of the insured’s coverage Benefits will increase each year at a rate of 5% of
the prior year’s amount Compared to the Standard Plan, premiums will be
two to three times greater, based on the insured’s age at time of purchase
19
New York Partnership Plan Conforms to Basic Plan design in accordance with the
New York Partnership for Long-Term Care Provides asset protection when/if Long-Term Care
benefits are exhausted Must be a resident of New York(or return to NY) to receive the
Medicaid Extended Coverage portion Does not include many of the features included in The
Research Foundation’s standard plans Emergency Alert, Caregiver Training, Care Assist Lower Community based care benefit percentage
20
New York Partnership Plan Basic Plan Design
Maximum Daily Benefit for Nursing Home$163(2003 minimum), $250
Community Based Care50% of nursing home benefit
Lifetime Maximum1095X(3 year) times the Daily Nursing Home Benefit
100 day waiting period before benefits begin 14 day respite benefit
Similar to care assist except respite care must be provided by a formal(licensed) caregiver
Lifetime Automatic Benefit Increase is includedRequired for the NY Partnership Plan
21
Portability
Continuation of Coverage No change in benefits / rates No action necessary by Insured Receives a bill directly from CNA
quarterly, semi-annually or annuallymonthly - electronic funds transfer
22
Qualifying for Benefits
Must have a qualifying impairment Unable to perform, without substantial assistance,
2 of 6 Activities of Daily Living
Bathing Transferring DressingContinence Toileting Eating Cognitive Impairment requiring substantial
supervision ( ex. Alzheimer’s Disease) Impairment certified by licensed health care
practitioner (i.e. physician) Satisfy 90 calendar day waiting period
23
Who Is Eligible For Coverage? Employees eligible for coverage
actively at work at least half time on a regular salaried schedule
6 months of employment On payroll at the time of application
When to enroll with Guaranteed Issue During Special Open Enrollment 4/1/03-4/30/03 Newly eligible for coverage - within 60 days following
completion of 6 months of employment Late Entrant Employees
If enrolling at any other time, must provide evidence of insurability and coverage is not guaranteed
24
Who Is Eligible For Coverage?
Certain family members Spouse / Domestic Partner of eligible employee
may apply at any time via a short form application
coverage is not guaranteed must provide evidence of insurability and
be approved
25
Who Is Eligible For Coverage?
Retirees and their spouses Parents, Parents-in-law Grandparents, Grandparents-in-law
may apply for coverage at anytime via a long form application
coverage is not guaranteed must provide evidence of insurability and
be approved
26
What Determines Your Premium Premiums are per individual Coverage selected
Daily Benefit, Lifetime Maximum, Optional Lifetime Automatic Benefit Increase
Age as of coverage effective date Effective date
Employees enrolling between April 1, 2003 through April 30, 2003….effective date is June 1, 2002
Others - First of the month following underwriting approval of coverage
27
Level Premiums
Premiums are based on age on effective date of coverage
Do not increase as you get older increases only if additional coverage is
purchasedor if
CNA requests increase in rates for all insureds
28
Payment of Premium
Payroll deduction Eligible Employees Their Spouses / Domestic Partners Premiums deducted on an after-tax basis
Direct bill Retirees and their spouses, Parents, Grandparents
(in-laws) Payment options available
quarterly, semi-annually or annuallymonthly-electronic funds transfer
29
Administration Leave of Absence
Not eligible for coverage until return to actively-at-work status
eligible for GI if done within eligibility timeframe (60 days following return to work)
Late Entrants Apply at anytime Coverage is not guaranteed Must complete short form application and be
approved
30
Administration
Changes / cancellations / decreases in coverage allowed throughout the year
Employees must call CNA Group Long-Term Care Customer Service
CNA will make appropriate changes once notified by telephone or written request
Will notify The Research Foundation via monthly payroll update / billing to discontinue payroll deductions
31
Administration
Effective Date of Coverage CNA sets effective dates for all insureds Effective dates are always the 1st of the month Effective dates based on
when enrollment forms / applications are received and coverage approved
Cut-off date for next monthly payroll / billing file
32
Administration Billing
(Central Office Responsibility) CNA sends monthly payroll update / billing file to
The Research Foundation statement will reflect payroll deduction
amount (Bi-Weekly) for each employee or spouse / domestic partner insured
shows deduction amount to be taken per pay period
Pass changes in payroll deductionsCodes N=new D=delete C=change
33
Administration Billing
(Central Office Responsibility) CNA will send a “short pay” statement to individual
insureds if: premium shortages occur no payroll deduction dollars received
CNA will direct bill participants due to leave of absence termination (offer continuation of coverage) after 90 days if no payroll deduction premium
received
34
Administration
Claims Notify CNA by calling 800 number Claim Specialist discusses
contract provisions claim process requests completion of authorization form -
medical records schedule appointment w/Care Manager
35
AdministrationClaims
Care Manager conducts telephone assessment interview gathers information about functional and
cognitive impairments identifies qualifying impairment Plan of Care is developed
36
CNA Contacts for The Research Foundation
Account Management-CorporateSteve March, National Account Manager407-919-1951 (fax 407-919-1882)[email protected]
Account Management-Sales and ServiceRoxanne Price, Account Service
Representative585-249-7925 (fax 585-249-7905)[email protected]
Day-to-day AdministrationRosemary Buchelli, Account Service Manager407-919-1920 (fax 407-919-1880)[email protected]
37
Employee Questions?
CNA CUSTOMER SERVICE:1-877-777-9072
HOURS OF OPERATION:Monday thru Friday
8:00 a.m. to 6:00 p.m. (ET)
CNA Web Site for The Research Foundation
www.ltcbenefits.compassword: trfsunygltc
38
Mailing Address
PO BOXCNA GLTC
P O Box 946760Maitland, FL 32794-9776
STREET ADDRESS/OVERNIGHTCNA GLTC
65 Keller RoadOrlando, FL 32810
