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Rev. Date. 1/3/2020
Illinois State University
Genworth Long Term Care Insurance | FAQs
List of Frequently Asked Questions
About Long Term Care Services ............................................. 2
What is Long Term Care? ....................................................... 2
Will I need Long Term Care? ................................................... 2
What would I need to pay for Long Term Care services if I don’t
have Long Term Care Insurance? ........................................... 2
About Long Term Care Insurance ........................................... 4
What is Long Term Care Insurance? ....................................... 4
Why should I consider Long Term Care Insurance? ............... 4
Should I wait until I’m older to buy Long Term Care Insurance?
................................................................................................. 4
What is medical underwriting? ................................................. 4
What is the difference between Long Term Disability and Long
Term Care Insurance? ............................................................. 4
Doesn’t our health / medical insurance cover Long Term Care?
................................................................................................. 5
Doesn’t Medicare cover Long Term Care? .............................. 5
About ISU’s Program ............................................................... 6
What coverage choices do I have under this plan and how do I
learn more about the program? ............................................... 6
How much does Long Term Care Insurance cost? ................. 6
Do my premiums increase as I age? ....................................... 6
When is the coverage effective? ............................................. 6
Do I continue to pay when I’m receiving benefits? .................. 6
How do I receive benefits? ...................................................... 6
When will this program start to pay benefits? ......................... 6
What is an “elimination or waiting period” and how does it work for
this program? .......................................................................... 6
What happens to my coverage if I leave ISU or when I retire? 7
What happens to my coverage if I move to a difference state?7
What are the payment options? .............................................. 7
If my family members apply, do I pay for their coverage? ....... 7
Can I pay for my Long Term Care Insurance premiums from my
Health Savings Account (HSA)? ............................................. 7
Can I deduct my premiums from my taxes? ............................ 7
Where can I find more information about tax qualification and long
term care insurance? .............................................................. 8
What happens if I miss a premium payment or can’t pay the full
amount? .................................................................................. 8
Can I cancel my coverage at any time? .................................. 8
Can I increase my coverage? ................................................. 8
Can premiums go up in the future? ......................................... 8
Applying for the ISU Program ................................................. 9
Who is eligible to apply* for Long Term Care Insurance coverage?
................................................................................................ 9
Do I need to apply in order for my eligible family members to
apply? ...................................................................................... 9
If age 75 is the oldest age for a family member to apply, does the
program end at age 75? .......................................................... 9
Why should I consider applying now? ..................................... 9
What are the medical underwriting requirements for the ISU
program? ............................................................................... 10
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About Long Term Care Services
What is Long Term Care?
Long term care is the kind of help you require for taking care of your personal needs, such as bathing, dressing, eating, continence,
toileting and transferring. These needs are commonly referred to as “Activities of Daily Living” or ADLs. You might need this kind of help
because of a chronic medical or physical condition. Frequently, people with Alzheimer’s disease or other health conditions may need
ongoing supervision as well because of cognitive impairment. Long term care covers a broad range of needs and services. Services to
meet those needs include care at home or in a community program like adult daycare, as well as assisted living facilities (residential care
facilities in CA) or nursing home care.
Will I need Long Term Care?
Anyone at any age may need long term care. An accident or a sudden, serious illness can create a need for care, as can the slow
progression of chronic diseases such as multiple sclerosis, rheumatoid arthritis, Alzheimer’s disease or Parkinson’s disease. When we
age, we may need help due to frailty, especially since we are living longer, leading healthier lifestyles and have better medical technology.
It is not surprising that about 70% of Americans will need some type of long term services and support after age 65 to help them with
everyday activities.
(Source: U.S. Department of Health and Human Services, (https://longtermcare.acl.gov/the-basics/how-much-care-will-you-
need.html). 10/10/17. Accessed 1/3/20).
What would I need to pay for Long Term Care services if I don’t have Long Term Care Insurance?
Costs for long term care services will vary by where you live, the level of care you need and where you are receiving services – such as
at home, in the community or in a facility. You can reference Genworth’s annual survey of care costs throughout the country at the ISU
Long Term Care Insurance website. This information will help show you what it costs in the area in which you live or expect to retire.
Below is a screenshot example of the costs for California followed by the national medical costs.
You may be interested to learn that based on Genworth claims data (through 12.31.2018), 73% of claimants receiving benefits started
with care at home and of those, 60% never transitioned.
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NATIONAL MEDIAN
Home Health Aide
$52,624 / year
Adult Daycare
$19,500 / year
Assisted Living Facility – Private Room
$48,612 / year
Nursing Home – Private Room
$102,200 / year
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About Long Term Care Insurance
What is Long Term Care Insurance?
Long term care insurance is designed to help you pay for the care you may need if you are chronically ill. That could include:
✓
Help with some of the everyday activities we often take for granted (like eating, bathing or dressing)
✓
Nursing home or residential care facility fees
✓
Benefits that can help you receive care in your own home
Why should I consider Long Term Care Insurance?
These are some reasons why people buy long term care insurance:
✓
It will cover care expenses over several years so you don’t drain your hard-earned savings and retirement income
✓
It gives you options to determine where you receive care and the quality of that care
✓
It protects your assets and retirement income so your loved ones maintain their lifestyle
✓
It enables your loved ones to supervise your care rather than provide the care
✓
Health insurance does not pay for long term care
Should I wait until I’m older to buy Long Term Care Insurance?
Long term care insurance premiums are based on your age when you apply. Typically, the younger you are, the lower your premiums
will be. You can wait to apply at an older age, but since it is a medically underwritten program, you may need to provide evidence of good
health to qualify. People tend to associate long term care with older age, but an accident or illness requiring long term care services could
happen at any time. Enrolling in long term care now can help ensure you’re covered for the unexpected.
What is medical underwriting?
Insurance companies screen people for medical conditions when they apply for long term care insurance. You will be asked a series of
health questions on the application and will be required to sign a release of your medical records so the insurance company can examine
them. Some companies will call or send someone to interview applicants to verify their physical and cognitive condition. A few companies
will accept you if you have certain chronic conditions, but your premiums are likely to be higher.
Companies selling this insurance will screen people for existing medical conditions when they apply for coverage. However, people who
are actively employed and apply through an employer group may be accepted with little health screening, or only be refused coverage
when they have a serious health condition. To learn about the underwriting requirements for the ISU program, see “ISU’ Program” in the
next section.
What is the difference between Long Term Disability and Long Term Care Insurance?
Many confuse Long Term Disability and Long Term Care Insurance. Both are triggered by health-related causes, but these two insurance
plans serve vastly different purposes. Long Term Disability Insurance is to help protect your future earnings. It is designed to replace a
portion of your income when you are not able to work due to a debilitating illness or disability accident.
Long Term Care Insurance pays a daily or monthly (ISU’s plan is a Monthly Benefit Amount) benefit toward the cost of services from a
nursing facility, assisted living facility, adult daycare, or home assistance when you can no longer take care of yourself for the activities
of daily living, such as bathing, dressing or eating.
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Doesn’t our health / medical insurance cover Long Term Care?
Health insurance is designed to cover short-term, acute care such as hospital stays, operations, prescription drugs and doctor visits. It
usually pays little toward long term care costs.
Doesn’t Medicare cover Long Term Care?
Many Americans believe Medicare pays for long term care services, yet Medicare is designed as health insurance. It will pay for limited
long term care services. For example, Medicare only pays for nursing home care if there is a prior qualifying hospital stay of at least three
days and skilled nursing or rehabilitative care is needed every day. The Medicare benefit for nursing home care will only last for a
maximum of 100 days and, in most cases, far fewer days.
Doesn’t Medicaid cover Long Term Care?
Medicaid is the government-funded program that pays for nursing home care only for individuals for are low income and have spent down
most of their assets. To get Medicaid help, you must meet federal and state guidelines for income and assets. State laws differ about
how much income and assets you can keep and still be eligible for Medicaid. Contact your state Medicaid office, office on aging, or
department of social services to learn about the rules in your state.
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About ISU’s Program
What coverage choices do I have under this plan and how do I learn more about the program?
For information about overage options under this plan, go to this website: http://www.genworth.com/ISU.
The website has a Learning Center and a Get A Quote section that include interactive tools to provide you with more information about
long term care, the insurance, and to help you understand the coverage options that are available. You can also call 1.800.416.3624
(Monday – Friday, 8am – 8pm ET) toll free to speak to a Genworth program expert.
How much does Long Term Care Insurance cost?
Premiums are based on the age that you apply and your plan options. Go to the website to Get A Quote. In the Get A Quote section, you
can select the different options and the monthly premoums costs. You will also have access to interactive tools that will provide more
information about your plan options.
Do my premiums increase as I age?
Your premium will not change due to a change in your age, health or claims status.
When is the coverage effective?
The coverage is effective the first of the month after your application has been processed and approved by Genworth Life. If you apply
during the special enrollment period, the soonest effective date is May 1, 2020.
Do I continue to pay when I’m receiving benefits?
No. Premium payments will be waived while you are receiving benefits in a facility, at home or in the community.
How do I receive benefits?
When you receive your certificate of coverage, you will receive a toll free number to contact Genworth Life. Should the need for a claim
arise, you or your representative should call that number. After speaking with an intake analyst, you will be contacted by a member of
the Care Coordination team. The Genworth Care Coordination team can help in developing your plan of care, providing information on
available long term care resources in your area and may sey up a face-to-face meeting and conduct a needs assessment.
When will this program start to pay benefits?
Benefits become payable under this program when:
✓
You need help with at least two “activities of daily living” and will likely need it for at least 90 days, OR
✓
You are diagnosed with a cognitive impairment that requires supervision, AND
✓
A medically licensed healthcare practitioner certifies that your condition qualifies you as being “chronically ill”
o
The activities of daily living that are eating, dressing, continence, transferring, bathing and toileting
In addition, the elimination period (also known as a “waiting period”) must be satisfied, and you must be receiving covered services under
a plan of care.
What is an “elimination or waiting period” and how does it work for this program?
Once you qualify for benefits, a “waiting period” of 90 calendar days starts on the first day you receive care and continues for 90 calendar
days while you remain chronically ill. You are not required to receive services during these 90 days. Once the elimination period is
satisfied, benefits for covered services become payable. You only have to satisfy one elimination period in a lifetime.
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What happens to my coverage if I leave ISU or when I retire?
The program is portable and Guaranteed Renewable. If you leave ISU or retire, coverage will remain inforce as long as the required
premium is paid and you have not exhausted the Maximum Lifetime Benefit. Coverage will not be canceled as long as premiums are
paid on time and cannot be canceled due to your age or because of a change in health. Premiums can only be changed with the Illinois
Department of Insurance’s approval and only on a group, not an individual, basis.
So, if you leave ISU you can still continue your long term care coverage as long as you pay your premiums on time. Your coverage stays
the same and your premiums stay the same.
What happens to my coverage if I move to a difference state?
If you move, your coverage continues at your current rate and coverage level. Benefits are payable in the United States and any territory
or possession of the United States. Also included in your coverage is an International Nursing Facility Benefit.
What are the payment options?
When you apply, you will have a few choices to pay for your coverage:
1.
Direct Bill on a quarterly, semi-annual or annual basis
2.
Electronic Funds Transfer from checking or savings on a monthly basis
If my family members apply, do I pay for their coverage?
No, when your family members apply, they will choose their payment option.
Can I pay for my Long Term Care Insurance premiums from my Health Savings Account (HSA)?
You can use your HSA money to pay premiums for an eligible long-term-care insurance policy, but the amount you can withdraw tax-free
each year is based on your age. The older you are, the more you can withdraw tax-free. The amount increases slightly every year, and
the limits are per person.
In 2020, here are the amounts you can withdraw from your HSA tax-free, to pay for your long term care insurance premiums:
Age
Annual Tax-Free Amount that can be Withdrawn from Your HSA
40 or younger
$430
41 – 50
$810
51 – 60
$1,630
61 – 70
$4,350
71 or older
$5,430
Can I deduct my premiums from my taxes?
If you don’t have a Health Savings Account (HSA) or you don’t use HSA money for these expenses, your long term care insurance
premiums may be tax deductible up to the same limits listed in the above question (can I pay for my long term care insurance premiums
from my Health Savings Account).
To qualify for the medical expense deduction in 2020, you must itemize, and your eligible medical expenses are deductible only to the
extent that they exceed 10% of your adjusted gross income. Your state may offer an additional break from your state income taxes for
qualified long term care insurance premiums.
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The ISU program is a federally qualified long term care insurance contract. Benefits paid for qualified long term care expenses are not
taxable as income.
Where can I find more information about tax qualification and long term care insurance?
For more information about tax qualified long term care insurance and the tax treatment of medical and dental expenses, consult IRS
Publication 502.
Everyone’s financial plan is different. So, as always, when you are making decisions regarding taxes, it is recommended that you consult
with your tax advisor and/or financial planner.
What happens if I miss a premium payment or can’t pay the full amount?
If you are not able to pay your full premiums on time there is an initial grace period of 31 days. If your premium has not been paid by the
end of that period, you will receive notice explaining that a payment was missed and your coverage is in danger of lapsing. The notice
will provide an additional 35 days to pay the unpaid premiums beginning on the date the notice is mailed.
Can I cancel my coverage at any time?
Yes, you can cancel your coverage at any time by notifying Genworth in writing.
Can I increase my coverage?
Yes, within the plan options available and with full medical underwriting. Please note there are benefit increase options you may choose
to increase your coverage automatically on an annual basis, or on a periodic basis with Future Purchase Options from Genworth. You
can find these plan options at the Get A Quote section of www.genworth.com/ISU, and in your Outline of Coverage at the Learning Center
of www.genworth.com/ISU.
Can premiums go up in the future?
Under certain circumstances, as set forth in long term care insurance contracts, a rate increase is warranted. Carriers need rate increases
to help manage costs as claims experience emerges. The potential for rate increases is disclosed on the first page of Genworth Life’s
certificates. No one likes rate increases, but they are necessary to ensure carriers’ ability to pay claims in the future.
As with all tax-qualified long term care insurance plans, premium will not change due to a change in an individual insured’s age or health.
Genworth Life reserves the right to increase premium rates and it is possible that rates may have to be increased in the future. Genworth
Life may change premiums either on a Group Policy or class basis; but only if we change premium for all similar Certificates issues under
the Group Policy in the same State. Any increase will be implemented in accordance with state requirements and may occur only once
during any 12-month period.
Genworth remains committed to the long term care insurance business, even as dozens of carriers have exited, as well as to our more
than 1 million long term care insurance policyholders, who depend on their coverage to help shoulder the potentially large financial burden
of long term care.
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Applying for the ISU Program
Who is eligible to apply* for Long Term Care Insurance coverage?
The long term care insurance program is available to:
✓
Benefit eligible employees who are actively at work, working at least 50% of a normal work period and are eligible for benefits
through Central Management Services (CMS) and retirement participation in the State Universities Retirement System (SURS).
✓
Family members of an eligible employee who is between the ages of 18 and 75, including:
o
Spouses, Civil Union Partners, and Domestic Partners
o
Parents, Parents-in-law, Step Parents, and Step Parents-in-law
o
Grandparents, Grandparents-in-law, Step Grandparents, and Step Grandparents-in-law
o
Adult Children and Step Children
o
Siblings, Siblings-in-law and Step Siblings
All applicants must maintain a permanent U.S. residence and have a valid Social Security Number or Tax Identification Number.
* Please note once you apply and are approved for coverage, your coverage continues as long as you pay your premiums.
Do I need to apply in order for my eligible family members to apply?
No, you do not need to apply in order for your eligible family members to apply.
If age 75 is the oldest age for a family member to apply, does the program end at age 75?
No, this program will continue as long as you continue to pay your premiums, or when your pool of benefits (Total Coverage Amount) is
exhausted.
Why should I consider applying now?
Benefit-eligible, actively-at-work employees under age 66 may apply with Modified Guaranteed Issue from March 2, 2020 – April 3, 2020.
If you wait to apply after the initial enrollment period ends, or if you are a benefit eligible employee older than age 65, you may apply with
full medical underwriting.
What is Modified Guaranteed Issue Comprehensive?
• Two disqualifying health questions
• Height / weight parameters
• Pre-existing conditions* limitation applies
* Pre-existing Conditions Limitation: Genworth Life will not pay for Covered Expenses incurred for any care or confinement that is a result
of a Pre-Existing Condition when the care or confinement begins within twelve months following the initial certificate effective date. A pre-
existing condition means a condition for which medical advice or treatment was recommended by, or received from, a provider of health
care services within six months prior to the initial certificate effective date.
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What are the medical underwriting requirements for the ISU program?
If you are:
You will use this process to apply:
If you’re benefit eligible and age 65 or younger, you can take advantage of a streamlined application process by:
✓
Online: Visit www.genworth.com/ISU.
✓
Via phone: Call 1.800.416.3624 (Monday through Friday, 8am – 8pm ET) toll-free to speak with a Genworth
program expert or order a printed information kit that contains important disclosures as well as applications you can
fill out, sign and mail.
o
Newly-hired, benefit-eligible employees age 65 and younger have 60 days to enroll in the plan after they
become benefit-eligible to take advantage of this streamlined application process.
o
Benefit eligible employees who are age 66 and older will need to go through full medical underwriting.
o
Spouses of a newly-hired, benefit-eligible employee between the ages of 18 and 75 can apply with full
medical underwriting.
o
All other eligible individuals (parents, parents-in-law, grandparents, grandparents-in-lage, siblings and adult
children) can apply anytime, with full medical underwriting.
o
After the initial enrollment period is over, anyone that is eligible can apply at any time with full medical
underwriting.