Department of Finance & Administration
Dave Goetz, Commissioner

Long-term care is a variety of services provided when an individual is unable to take care of themselves without the assistance of others due primarily to an injury, chronic illness, advanced age or cognitive impairment. This loss of functional capacity requires that the individual receive personal care services because they are not able to perform activities normally associated with daily living. What are the activities of daily living? — bathing, dressing, transferring (getting in and out of a bed or chair), eating, toileting and continence. In cases of cognitive impairment these maintenance activities may involve supervision of the individual. Covered individuals qualify for benefits by demonstrating the inability to perform two of the activities of daily living or by suffering from cognitive impairment.

The program is structured so that you make choices in the amount and duration of coverage. The benefit choices are the ones, other than your age, which will determine the amount of the monthly premium.

First, you choose from three daily benefit amount levels: $100, $150 or $200 per day for room and board in an assisted living or nursing home setting and a corresponding benefit for home care, adult day care, hospice and respite care of $60, $90 or $120.

Next, you decide on the benefit period of either three years (1095 days) or five years (1825 days). This is the duration of time your benefits will last if you spend the daily benefit amount. Should you use less than the daily maximum, your benefits will actually last longer.

And, finally, you may choose to add inflation protection, which will increase your daily benefit amount at the compounded inflation rate of five percent annually. If you choose not to include inflation protection, the amounts will remain the same regardless of the impact of the cost of these services due to inflation. Choosing the inflation protection option will result in a higher premium; however, the value of your coverage you purchase today will be increased to offset rising long-term care costs.

In addition to these choices, there are a number of fixed features associated with the long-term care plan. There is a 90-day elimination period that must be met — much like a deductible — by having an individual qualify for long-term care services before the insurance coverage begins to pay for those services. To qualify, the individual must be unable to perform two activities of daily living or by needing supervision due to cognitive impairment. Receipt of long-term care services is not a requirement for meeting the elimination period; certification of activities of daily living or cognitive impairment is all that is necessary. Meeting this deductible qualification does not mean that an individuals' needs be consecutive in day usage as long as the individual's needs are evident within a 365 day period.

New employees have 90 days to enroll and have guaranteed issue of coverage. Employees may sign-up for coverage by completing the enrollment form enclosed in the enrollment kit, over the phone by speaking with a customer service representative at MedAmerica Insurance Company or on-line via the website at www.ltc-tn.com. The employee's spouse, eligible dependent children, parents and parents-in-law may also apply for coverage; however, they must provide information about their health status. After the initial guaranteed issue period, employees may still apply for coverage, but will be subject to the same medical underwriting review for approval to participate.

The premiums for long-term care insurance are based on your age at the time of enrollment. Therefore, the younger you are when you apply, the lower your monthly premium will be. Please see the Long-Term Care Premium Page for a complete list of premiums.