Nemours offers long-term care (LTC) coverage through the convenience of post-tax payroll deductions for both associates and their spouses. Direct billed coverage is also available to the parents and grandparents of associates and their spouses. Coverage for LTC insurance is fully portable.
LTC coverage provides an allowance for custodial assistance to individuals who are unable to perform two of six Activities of Daily Living (ADL) due to a disability. ADLs include bathing, dressing, eating, toileting (grooming), continence (using the bathroom without help) and transferring (moving from the bed to a chair, or vice versa). LTC is also payable if the subscriber has a cognitive impairment.
Custodial assistance may be provided by any of the following: a skilled nursing facility, a home health care agency (called professional home care), an assisted living facility, or a member of the community (total home care, including your family members).
Newly eligible associates may elect LTC coverage without providing evidence of insurability (EOI) within 30 days of their eligibility effective date. All elections for late enrollees are subject to EOI determination; all elections made by eligible dependents are also subject to EOI.
| Provision Options | 3-Year Benefit Duration | 6-Year Benefit Duration |
|---|---|---|
| Monthly Facility Benefit Amount Options | $1,000 to $4,000 | $1,000 to $4,000 |
| Skilled Nursing Facility* | 100% | 100% |
| Assisted Living Facility* | 60% | 60% |
| Total/Professional Home Care | 50% | 50% |
*LTC pays a percent of the total monthly facility benefit amount, based on where services are received. For example, if a facility monthly benefit amount of $1,000 was elected, and services were received at a skilled nursing facility, the benefit amount received would be 100% of $1,000; equaling $1,000 of benefit per month. However, if a facility benefit monthly benefit amount of $1,000 was elected, and services were rendered at an assisted living facility, the benefit amount received would be 60% of $1,000; equaling $600 of benefit per month.
**The lifetime maximum does not change based on where you receive services. If the facility benefit amount elected is $1,000 for a three-year benefit duration, the lifetime maximum is $36,000. For example, if the subscriber is confined to a nursing home, he/she/they would receive the benefit for a duration of three years; assuming the same election, but if services are received at home, the benefit would be pro-rated accordingly, and $500 would be the benefit received for a maximum duration of six years.