State of New Jersey Public Employees Long Term Care Group Insurance Plan Long Term Care Introduction Long term care comprises a broad range of services needed by persons of all ages with physical or mental impairments who have lost their ability to function independently. People who need assistance in performing at least two (2) activities of daily living, such as bathing, dressing, toileting, transferring (moving in and out of bed or chair), eating, and continence, are considered to be in need of long term care. Individuals with a cognitive impairment are also generally considered to need long term care. 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 needed on a regular basis over a period of several months, several years, or a lifetime. The State of New Jersey Public Employees Long Term Care Group Insurance Plan The State of New Jersey Public Employees Long Term Care Group Insurance Plan (Plan) will pay a daily benefit amount toward the cost of care in the home and community, such as home health care, adult day care, informal care, and care that is provided in licensed facilities, such as assisted living and nursing homes. Eligible active and retired employees and their eligible family members have several choices of daily benefit levels, as well as a number of benefit options to choose from. The Plan provides care management services, resource and referral services, and respite care, offering relief for the friend or family member who is caring for the covered employee or family member. Enrollment Eligibility Enrollment in the State of New Jersey Public Employees Long Term Care Group Insurance Plan is open to full-time employees of Kean University, and their eligible family members; Eligible family members will include: The spouse of each employee; adult children and stepchildren; parents, stepparents and parents-in-law; grandparents, step-grandparents and grandparents-in-law of the employee. Enrollment Deadline Full-time employees who apply within 90 days of hire will only be required to complete a short-form application which requires limited health information. If you apply, after the 90 days period immediately following your date of hire, you will be required to complete a long-form application requiring a full medical questionnaire. Prudential will, generally, determine if you can be enrolled based on the information provided on your application. Medical examinations are not required for any applicant. Payment Employees are permitted to request a payroll deduction for themselves and a spouse. All other enrolled individuals will be offered direct home billing arrangements. Cost 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: https://gltc.prudential.com/gltc/nj, 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. Additional Information Information can be obtained by visiting The Division of Pensions and Benefits Long Term Care Information Page at http://www.state.nj.us/treasury/pensions/ltchomepg.shtml or the Prudential LTC website at https://gltc.prudential.com/gltc/nj. You may also call 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 an employee of Kean University. LONG TERM CARE - Q & A 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. 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. 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. 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. 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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