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Questions
& Answers
For additional information, please view Prudential's Long Term Care Audio Presentation
(Runs 16 minutes, 35 seconds)
1.
What is long term care?
Individuals need long-term care when a chronic condition, trauma, or illness limits their ability to carry out basic self-care tasks, called activities of daily living (ADLs), (such as bathing, dressing or eating), or instrumental activities of daily living (IADLs) (such as household chores, meal preparation or managing money).
Long term care comprises a broad range of services provided to persons of all ages who have lost their ability to function independently because of a physical or mental impairment. Long-term care differs from other types of health care in that its goal is not to cure an illness, but to allow an individual to attain and maintain an optimal level of functioning.
Long term care services include personal care, home health care, rehabilitation, adult day care, care management, social services, assisted living, and nursing home services. Long term care services may be delivered on a regular basis or intermittent over a period of several months, several years, or a lifetime.
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2. Isn't long term care insurance just for the elderly?
No, people of all ages may require long term care. There are numerous medical or physical conditions that frequently result in an individual requiring long term care services. Statistics show that 40 percent of the people needing long-term care services are adults under age 65. However, older people are the primary users of long term care services because the risk of functional disability increases with advancing age.
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3.
What conditions may lead to a need for long term care?
The list of conditions that may trigger the need for long term care is lengthy. It includes, but is not limited to: spinal cord injuries, stroke, physical frailty, Alzheimer’s disease, Huntington’s disease, dementia, senility, AIDS, and the long term effects of diabetes, autoimmune disorders such as rheumatoid arthritis, circulatory diseases and heart conditions, Parkinson’s disease, Amyotrophic Lateral Sclerosis (also known as Lou Gehrig’s Disease), and multiple sclerosis.
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4.
Who provides long term care?
While a significant amount of long-term care is provided by licensed individuals, a 2004 study conducted by the National Alliance of Caregiving and the AARP indicates that there are some 44.4 million adult caregivers* in the U.S. According to the study, on average, those caregivers provide 21 hours of care a week, and the average length of time spent providing care is 4.3 years.
Nearly 60 percent of caregivers either work or have worked while providing care, with many having to make adjustments to their work life, including reporting late to work or even giving up their jobs entirely.
*Caregiver: An individual, such as a parent, foster parent, or head of a household, who attends to the needs of a child or dependent adult.
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5.
Isn't most long term care delivered in a nursing home?
Not really. Many of the diseases that ultimately result in a person requiring long term care are progressive and degenerative.
In the early stages of a disease, the individual may need part-time assistance with certain daily chores. Later as independence becomes more challenging, the person may live with relatives or friends, or possibly move into some type of assisted living arrangement, and only when full-time care is needed, a nursing home. Sometimes individuals who normally need care in nursing home are permitted to remain in an assisted living arrangement if facility can provide the necessary care. Many older people have functional limitations and need ongoing assistance, yet are not so disabled as to require nursing home care.
The American Association of Homes and Services for the Aging reports: There are more than 1.6 million residents in nursing homes; more than a million Americans live in assisted living residences; approximately 725,000 residents live in Continuing Care Retriremt Communities; adult day centers provide care for 150,000 older Americans each day; and the number of current home health care patients is 1.4 million.
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6. Doesn't my group health insurance plan and Medicare
cover the cost of care?
Group health insurance plans cover the cost of treatment for illnesses but do not cover services that may be considered custodial in nature or just support activities of daily living. Therefore, they do not cover the cost of most long term care services. Medicare only plays a small role. For example, Medicare will only cover 100 days of treatment in a skilled nursing facility after a hospital stay of at least three days; beneficiaries must make a high coinsurance payment from days 21-100. Most long term care is not skilled care and does not follow a hospital stay.
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7.
What about Medicaid?
Coverage under Medicaid, which is a joint federal and state program, is based on financial need. Recently the federal Medicaid rules were amended with the intention of limiting the number of people who have access to its benefits. Also, each state has its own specific requirements, but generally each requires that the applicant demonstrate that his or her income is very limited and he or she have minimal assets before the program begins to pay benefits. In many instances a person must spend down his or her assets before he or she can qualify for Medicaid. In New Jersey, if you have non-exempt assets valued at over $2,000 for an individual, or $3,000 for a married couple, or income above a minimal amount, you will probably not be considered eligible for Medicaid until your assets that exceed those limits are depleted. Even if you qualify, your choices of where and how you receive care can be severely limited.
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8.
What does the long term care insurance plan (Plan) for public employees
and retirees in the State of New Jersey cover?
The Plan pays a daily benefit amount toward the cost of care in the home and community- home health care, adult day care, informal care, and care that is provided in licensed facilities such as assisted living and nursing homes. There are several choices of the daily facility benefit amount payable – ranging from $100 to $250 per day, and a choice of 50% or 75% of the daily benefit amount that will be provided for home and community-based care. The Plan also provides care management services, resource and referral services, and respite care which offersrelief to the friend or family member who is caring for you.
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9. Isn't long term care insurance very expensive?
Like life insurance, the younger you are when you add this benefit to your financial plan, the less expensive it is. Your age at the time you purchase the insurance is the primary factor in determining your cost for a basic policy. The cost increases depending on whether you choose to add optional benefits to the basic policy or if you choose to increase your benefit over time to account for inflation.
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10.
If I need long term care I will not want to be placed in a
nursing home. Can I avoid being placed in one?
Long term care insurance can help you stay in your home or in the home of others, such as the home of a friend or relative. For example, you can use your daily benefit to help you pay for services such as home health aides, caregiver training, and adult day care. Prudential’s care counselors and referral services can assist you in locating and utilizing local services that can help you stay independent. Should your needs increase, you can then apply your benefit toward an assisted living facility or a nursing home.
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11.
Who is eligible to enroll in the plan?
Generally, all active employees of the State who are paid through the State's Centralized Payroll Unit; most employees of State colleges and universities; retired employees of the State of New Jersey and its colleges and universities can enroll in the Plan. Employees of most Local public employers in the State can enroll in the Plan provided the Local has adopted a resolution offering the coverage to its active and retireed employee. An extensive list of relatives of individuals eligible to enroll in the Plan are also eligible to enroll in the Plan.
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12.
Which relatives are eligible?
The spouse of each active and retired employee; adult children and stepchildren; parents, stepparents and parents-in-law; grandparents, step-grandparents and grandparents-in-law of the employee.
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13.
Are employees of local governmental entities and boards of
education able to enroll in the Plan?
Yes, active and retired employees, and their eligible family members can enroll in the Plan after the employee’s Local governmental or educational employing entity adopts a resolution to participate in the Plan. Until the Local employer adopts the resolution, neither employees, retirees, or eligible family members may apply for coverage.
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14.
How will premiums be paid?
For most active State employees, the premiums are deducted from their paycheck. Generally all other active and retired employees and their covered family members will be directly billed by Prudential.
Employees are only be permitted to authorize a payroll deduction for themselves and his or her spouse. All other enrolled individuals will be offered direct home billing arrangements.
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15.
Will I be able to change my coverage should my circumstances
change?
Yes, you always have the opportunity to change your coverage.
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16.
What happens if I stop paying my premium or drop my coverage?
At the time you purchase your policy, you may elect to include a feature called a "shortened benefit period" option in your policy. Under the shortened benefit period, if you voluntarily stop paying your premiums after you have been covered by the Plan for three years, you will still be entitled to your benefits. However, you will only receive them for a limited period of time. Your maximum lifetime benefit would then be reduced to equal the amount of premiums you have paid, less any benefits received under the Plan, but not less than 30 times the Nursing Home Daily Maximum benefit you elected when you purchased the coverage.
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17.
Will I have to have a medical examination in order to enroll
in the program?
No. Medical examinations are not be required for any applicant. Prudential will, generally, determine if you can be enrolled based on the information provided on your application.
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18.
If I terminate my employment will my coverage terminate?
No. Your coverage will remain in effect as long as you continue to pay premiums directly to Prudential. The monthly premium you will pay will be the same as the premium you paid prior to your termination of employment. You can also pay your premium less frequently in which case Prudential will discount the amount you pay.
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19.
If an insured active employee or retiree predeceases any other covered related person, what happens to the coverage of the
relative?
The death of the employee or retiree through whom coverage was obtained has no impact on the relative's coverage. Each covered person will continue to have their own coverage remain in effect, as long he or she pays his or her premium.
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20.
Will I able to choose the coverage I want?
The Plan is designed to offer eligible individuals a variety of choices of coverage.
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21.
Will the Plan pay for my long term care expenses regardless
of where I live?
As long as the expenses are incurred in the United States, the Plan will reimburse you up to the benefit limits you purchased.
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22.
How can I receive information describing the Plan?
Information can be obtained by clicking on the State of New Jersey Long Term Care Insurance Plan or by calling Prudential's Long Term Care Customer Service Center at 1-877–582-4865. When calling Prudential's Long Term Care Customer Service Center, please identify yourself as either an employee or retiree of the State of New Jersey; one of its colleges or universities; or by telling the customer service representative the name of your employer.
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23. When can I enroll in the Plan ?
If you are an employee of the State of New Jersey or one of its colleges and universities you can apply immediately after being hired. If you are an active or retired employee of a Local employer you will be able to apply for coverage shortly after the Local employer adopts the applicable resolution.
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24.
If I don't enroll during my initial enrollment period, can I enroll
at a later date?
Yes; however, it is important that you recognize two things. Individuals who do not apply for coverage when first eligible and decide to apply at a later date, may find that their health has changed and that Prudential may decline to offer them coverage. Even if they do qualify for coverage, the premium will be greater, as premiums are based on the individual applicant's attained age.
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25.
How can I find out the cost of enrolling in the Plan?
The rates for the basic plans are contained in Prudential’s information/enrollment kit and on the dedicated web site that the Prudential Insurance Company has developed for the Plan. You can access Prudential's web site through the Division of Pension and Benefits Internet home page at: www.state.nj.us/treasury/pensions/, or you can call Prudential's Long Term Care Insurance Customer Service Center at 1-877-582-4865 to request that an information/enrollment kit be sent to you.
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