Group Long Term Care Insurance

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hould You Opt Out?
Employers • Employees • The Nation
           Table of Contents                                Overview
                                                            Included	in	the	906-page	legislation	commonly	known	as	the	"health-
    2      Overview                                         care	reform"	act,	lies	a	19-page	section	addressing	an	important	
    3      The Long-Term Care Challenge                     issue	likely	to	impact	you,	your	employees	and	your	company.
    	      	       •	What	does	it	cost?
                                                            The	Community	Living	Assistance	Services	and	Supports	Act,	or	
    	      	       •	Who	pays	the	bill?                     CLASS	Act,	is	part	of	the	Patient	Protection	and	Affordable	Care	
    	      	       •	What	is	the	impact	on	your	business?   Act	signed	into	law	by	President	Obama	in	March	2010.	The	CLASS	
    5		    History	and	Intent	of	the	CLASS	Act              Act	establishes	a	national	government-run	long-term	care	insurance	
                                                            program,	to	be	offered	primarily	through	employers.	The	legislation	
    6      Timeline                                         signals	the	government's	recognition	of	the	need	for	long-term	care	
    6		    What	CLASS	Requires	of	Employers                 planning.	People	of	any	age	can	require	long-term	care	services	and	
                                                            few	are	equipped	to	pay	the	high	price	associated	with	such	care.	In	
    7		    CLASS	Eligibility	and	Benefits
                                                            the	majority	of	cases,	care	is	provided	by	family	members	or	other	
    	      	       •	Who	is	eligible	for	coverage?          unpaid	caregivers,	a	situation	that	ultimately	affects	employers.	
    	      	       •	When	are	benefits	paid?                According	to	one	study,	productivity	losses	resulting	from	the	burden	
                                                            of	caregiving	cost	businesses	an	estimated	$33.6	billion	annually.
    	      	       •	How	much	are	benefits?
    	      	       •	Who	can	provide	care?                  The	CLASS	Act	is	the	federal	government's	attempt	to	offer	long-term	
    8		    Enrollment	Provisions                            care	coverage	to	as	many	people	as	possible.	However,	the	legisla-
                                                            tion	has	its	share	of	shortcomings.	Areas	of	concern	include	inade-
    9	     Important	Considerations
                                                            quate	benefits,	expensive	premiums	and	uncertain	long-term	viability.
    	      	       •	Benefit	levels
    	      	       •	Premium	rates                          Nonetheless,	the	CLASS	Act	is	bringing	to	light	the	value	of	long-term	
                                                            care	insurance	as	an	important	estate	planning	and	financial	preser-
    	      	       •	Five-year	vesting	requirement          vation	strategy.	As	an	employer,	you	will	decide	to	opt	in	or	opt	out	
    	      	       •	Dependent	coverage                     of	the	CLASS	program.	Your	employees	will	automatically	be	en-
    	      	       •	Underwriting                           rolled	unless	they	elect	to	opt	out, whether the program is offered
                                                            through your workplace or other alternative means of enrollment
    	      	       •	Long-term	viability                    as yet to be determined by Department of Health and Human
    13		   Conclusion                                       Services.

                                                            Many	employers	will	choose	to	instead	offer	employees	private	long-
                                                            term	care	insurance.	This	alternative	is	relieving	employers	of	the	
                                                            burdensome	administrative	tasks	inherent	in	CLASS	participation,	
                                                            as	well	as	providing	employees	access	to	significantly	more	secure,
                                                            flexible	and	cost	effective	solutions	to	long-term	care	needs.	The
                                                            CLASS Program though may provide an excellent option for
                                                            those employees who are unable to qualify, because of poor
                                                            health, for a private long term care insurance policy.

1                                                                                                                                     2
                                                                               •	 A	yearlong	stay	in	a	nursing	home	costs	$83,585	for	a	private	
      The Long-Term Care Challenge                                                room	or	$74,825	for	a	semi-private	room.
                                                                               •	 The	monthly	base	rate	in	an	assisted	living	community	rings	up	at	
    Compared	to	the	number	of	people	who	will	need	long-term	care	at	             $3,293.
    some	point	in	their	life,	relatively	few	have	planned	accordingly.	Mis-
    conceptions	about	the	likelihood	of	needing	care,	its	cost	and	who	        •	 Hourly	rates	for	home	health	aides	average	out	at	$21.	Daily	rates	
    will	foot	the	bill	may	be	to	blame.                                           for	adult	day	services	come	in	at	$67.

    In	reality,	an	estimated	12	million	Americans	of	all	ages	currently	       As	high	as	rates	are	today,	they	will	inevitably	continue	to	increase	
    need	long	term	care	services	and	40%	of	nursing	home	residents	            in	the	future.	From	2004	to	2010,	the	compound	annual	growth	rate	
    are	under	the	age	of	65,	debunking	the	myth	long	term	care	is	solely	      averaged	six	percent	according	to	one	report.
    an	issue	for	the	elderly.1	Unable	to	fully	care	for	themselves,	individ-
    uals	receive	long	term	care	in	a	variety	of	settings	including	at	home	    Who pays the bill?
    or	in	an	assisted	living	or	skilled	nursing	facility.
                                                                               All	too	often,	a	long-term	care	event	wipes	out	a	person’s	savings.	
                                                                               Contrary	to	popular	belief,	most	long-term	care	services	are	not	cov-
    What does it cost?                                                         ered	by	Medicare,	major	medical	or	disability	insurance	policies.	In	
    Like	healthcare	in	general,	long-term	care	comes	with	a	hefty	price	       addition,	the	future	of	both	Medicare	and	Medicaid	is	facing	serious	
    tag	attached.	MetLife	Mature	Market	Institute's	2010	Market	Survey	        financial	challenges	due	to	an	aging	population.
    of	Long	Term	Care	Costs	offers	this	glance	at	national	average	long-
    term	care	rates:                                                           Individuals	with	reasonable	income	and	assets	will	most	likely	fi-
                                                                               nance	longterm	care	on	their	own,	making	long-term	care	insurance	
    Get	a	Long-term	care	insurance	quote	here.                                 a	wise	investment.

                                      In 20 years it will cost
                                          $ 619,769.18                         What is the impact on your business?
                                        For 3 years of care                    With	an	increasingly	older	population,	demographic	trends	indicate	
                                                                               that	more	and	more	employees	of	all	ages	will	assume	the	role	of	
                                                                               family	caregiver.	Studies	show	that	employees	with	caregiving	re-
                                                                               sponsibilities	are	more	likely	to	experience	health	conditions	from	
                                                                               depression	to	diabetes,	costing	employers	8%	more	in	healthcare	
                                                                               costs	for	these	employees	than	non-caregiving	workers.

                                                                               In	addition,	employers	are	experiencing	productivity	losses	due	to	
                                                                               issues	such	as	absenteeism,	workplace	disruptions	and	reduced	job	
                                                                               status	of	working	caregivers,	costing	them	as	much	as	$33.6	billion	
                                                                               a	year	nationally.2

                                                                               In	addition	to	protection	from	these	financial	threats,	many	employ-
                                                                               ers	view	long	term	care	insurance	as	a	way	protect	the	retirement	
                                                                               assets	their	employees	are	accumulating	through	their	401K	and	
                                                                               pension	programs.	Not	surprisingly,	long-term	care	insurance	has	
                                                                               emerged	as	one	of	the	most	sought	after	employee	and	executive	
3                                                                                                        4
       Total Estimated Cost to Employers of All Full Time Employed Caregivers
                                                                                                     Although	the	CLASS	Act	became	law	in	spring	2010,	several	details	
                                             Cost per Employee               Total Employer Cost
                                                                                                     have	yet	to	be	decided,	leaving	prospective	participants	with	many	
     Replacing Employees                             $413                     $6,585,310,888
                                                                                                     unanswered	questions.	Answers	should	be	forthcoming	as	the	
     Absenteeism                                     $320                     $5,096,925,912
     Partial Absenteeism                             $121                     $1,923,730,754
                                                                                                     Department	of	Health	&	Human	Services	works	through	the	legisla-
     Workday Interruptions                           $394                     $6,282,281,750
                                                                                                     tion's	complexities.
     Eldercare Crisis                                $238                     $3,799,082,202
     Supervisor Time                                 $113                     $1,796,385,842         The	following	target	dates	have	been	set:
     Unpaid Leave                                    $212                     $3,377,082,202
     Full-Time to Part-Time                          $299                     $4,758,135,522         			January	1,	2011	-	Program	becomes	effective
     Total                                          $2,110                   $33,619,070,346
    MetLife	Care	Giving	Cost	Study:	Productivity	Loss	to	US	Business,	2006                           			January	1,	2012	-	Eligibility	requirements	will	be	announced		

                                                                                                     			October	1,	2012	-	Premium	rates	will	be	determined
    History & Intent of the CLASS Act
                                                                                                     			June	30,	2013	-	Estimated	rollout	to	employers
    For	decades,	the	federal	government	has	been	trying	to	encourage	
    Americans	to	buy	long-term	care	insurance.	Past	efforts	include	the	                             			January	1,	2014	-	Initial	annual	report	on	solvency	due	to	Congress
    creation	of	tax	incentives	for	individuals	and	employers	who	purchase	
    long-term	care	insurance	policies.
                                                                                                     What CLASS Requires of Employers
    The	government	itself	is	not	in	a	position	to	pay	the	bill	for	Ameri-
    cans'	long	term	care.	Medicare provides almost no benefits and                                   As	an	employer,	you	will	be	required	to	make	a	decision	about	whether	
    Medicaid (welfare) is designed to pay only after individuals have                                to	opt	in	or	opt	out	of	the	CLASS	program.	Employers	who	choose	
    expended their own financial resources to near poverty levels                                    to	participate	in	CLASS	should	fully	understand	what	the	program	
    before meeting Medicaid requirements.                                                            will	demand	of	them,	as	well	as	what	it	will	and	will	not	deliver	to	their	
    In	an	attempt	to	help	working	Americans	pay	for	care	in	their	homes	
    or	community	if	inflicted	with	functional	impairments,	the	late	Sena-                            Companies	will	be	required	to	handle	administration	of	the	program	
    tor	Ted	Kennedy	introduced	the	CLASS	Act	in	2004.	The	legislation	                               including	setting	up	an	auto-enrollment	process,	managing	the	opt-out	
    was	signed	into	law	as	part	of	the	healthcare	reform	act	on	March	23,	                           option	for	employees	declining	participation,	processing	payroll	de-
    2010.                                                                                            ductions	for	premium	for	participating	employees,	and	remitting	
                                                                                                     premiums	to	the	federal	government.	Beyond	that,	the	Department	of	
    It’s	purpose	is	to	establish	a	national	voluntary	program	for	purchas-                           Health	and	Human	Services	has	yet	to	clearly	define	the	role	
    ing	community	living	assisted	services	in	order	to:                                              businesses	will	play	in	funding	the	administrative	cost	of	CLASS.

    1.	 Provide	individuals	with	functional	limitations	the	tools	to	allow	them	to	maintain	their	   To	avoid	taking	on	uncertain	costs	and	possibly	paying	the	price	of	the	
        personal	and	financial	independence	through	a	new	financing	strategy	for	community	
        living	assistance	services                                                                   federal	government's	learning	curve,	many	employers	are	exploring	
                                                                                                     alternate	longterm	care	coverage	options	in	the	private	sector.
    2.	 Establish	an	infrastructure	for	such	services;	

    3.	 Alleviate	burdens	on	family	caregivers;	

    4.	 Address	current	bias	toward	institutional	care	by	providing	financing	and	infrastructure	
        that	supports	personal	choice	and	independence.
5                                                                                                                                                                                  6
         CLASS Eligibility & Benefits                                                       Enrollment Provisions
    Who is eligible for coverage?                                                Employers	participating	in	the	CLASS	program	will	automatically	
    Individuals	18	years	or	older	who	earn	wages	subject	to	Social	              enroll	their	employees	unless	employees	specifically	opt	out.	The	
    Security	taxes	will	be	eligible	for	CLASS	coverage	regardless	of	            legislation	outlines	the	following	provisions	pertaining	to	enrollment,	
    any	pre-existing	medical	conditions.	There	is	no	further	underwrit-          disenrollment	and	re-enrollment.
    ing	beyond	the	requirement	that	the	employee	is	"actively-at-work."	
    Self-employed	people	paying	associated	self-employment	taxes	will	
    also	be	eligible.                                                               Initial Opt Out
                                                                                    Employees	who	choose	to	opt	out	when	the	CLASS	program	is	
    However,	unlike	private	long-term	care	insurance,	an	employee's	                first	offered	to	them	may	subsequently	enroll	only	during	open	
    family	members	are	not	eligible	to	enroll	in	the	CLASS	program	un-              enrollment	periods	to	be	scheduled	by	the	government	biennially,	
    der	the	employee's	plan.                                                        at	most.

    When are benefits paid?                                                         Unemployment After Enrollment
    To	be	eligible	for	benefits,	participants	must	first	complete	a	five-year	
                                                                                    Program	participants	who	leave	their	jobs	are	eligible	to	remain	in	
    vesting	period,	which	entails	paying	premiums	for	five	years	and	
                                                                                    the	program	as	long	as	they	continue	to	make	premium	payments.
    having	been	employed	for	at	least	three	of	those	years.

    Benefits	will	be	payable	when	a	vested	participant	has	a	functional	            Opting Out Post-Enrollment
    limitation	expected	to	last	at	least	90	days	that	involves	a	loss	of	two	
                                                                                    Individuals	enrolled	in	the	program	can	choose	to	end	coverage	
    or	more	Activities	of	Daily	Living,	or	has	severe	cognitive	impairment.	
                                                                                    only	during	an	annual	disenrollment	period.	However,	disenroll-
    Activities	of	Daily	Living	include	bathing,	dressing,	toileting,	transfer-      ment	for	failure	to	pay	premiums	can	happen	at	any	time.
    ring,	continence	and	eating.

    Benefits	will	be	paid	for	as	long	as	the	covered	individual	can	prove	          Lapsed Coverage
    that	benefit	eligibility	criteria	continue	to	be	met.                           Participants	who	fail	to	make	premium	payments	for	three	months	
                                                                                    will	be	considered	a	new	enrollee	if	they	choose	to	begin	making	
    How much are benefits?                                                          payments	again.	Premiums	will	be	recalculated	based	on	the	par-
    For	participants	determined	to	be	eligible	for	benefits,	the	CLASS	             ticipant's	age	at	the	time	of	re-enrollment.
    guarantees	an	average	cash	benefit	of	at	least	$50	a	day.	The	benefit	
    amount	will	be	dependent	on	the	degree	of	impairment,	and	will	be	              Re-Enrollment Credit & Penalty
    adjusted	annually	for	inflation	based	on	the	CPI.
                                                                                    Credit	toward	the	five-year	vesting	requirement	will	be	given	to	
                                                                                    participants	who	re-enroll	within	five	years	of	letting	coverage	
    Who can provide care?                                                           lapse.	Participants	who	re-enroll	after	a	five-year	lapse	will	not	
    Benefits	are	payable	whether	or	not	any	formal	services	are	being	              receive	credit	for	previous	coverage,	and	will	be	subject	to	an	
    received,	and	may	be	used	to	compensate	relatives,	friends	or	                  additional	premium	penalty.
    hired	help	who	are	providing	care.	Benefits	can	also	be	applied	
    toward	the	cost	of	services	provided	at	an	assisted	living	facility	
    or	nursing	home.
                                                                                    Read	more	about	group	long-term	care	insurance	here.

7                                                                                                                                                           8
    Fina	a	Long-term	care	agent
            Important Considerations
    In	light	of	the	approaching	implementation	of	the	CLASS	program,	          Private	long-term	care	insurance	policyholders,	on	the	other	hand,	
    now	is	an	excellent	time	to	learn	about	long-term	care	insurance	          are	able	to	select	benefit	levels	that	more	closely	reflect	the	actual	
    options	available	to	you.	When	deciding	which	route	is	the	best	fit	for	   cost	of	services.	Most	private	long-term	care	plans	come	with	daily	
    your	company	and	employees,	you	are	advised	to	take	the	following	         benefits	of	$100	to	$400.	Policyholders	can	also	elect	to	add	inflation	
    aspects	of	the	CLASS	program	into	consideration.                           protection,	with	options	including	an	unlimited	five-percent	com-
                                                                               pounding	factor.	Furthermore,	an	insurance	company	cannot	reduce	
                                                                               benefits	after	policy	issuance.
    Benefit Levels
    The	CLASS	program	is	expected	to	pay	benefits	between	$50	and	             Premium Rates
    $75	a	day.	The	amount	will	increase	each	year	based	on	a	consumer	
    price	index.	However,	the	government	may	also	reduce	program	              One	of	the	most	highly	anticipated	pieces	of	information	yet	to	be	
    benefits	to	ensure	financial	viability	of	the	program.                     released	about	the	CLASS	program	is	the	premium	rates.	The	Secre-
                                                                               tary	of	Health	and	Human	Services	is	expected	to	have	rates	formu-
    Unfortunately,	CLASS	benefits	fall	short	when	compared	to	the	ac-          lated	by	October	1,	2012.	In	the	meantime,	there	are	projections	that	
    tual	cost	of	care.	For	instance,	the	price	of	a	single	day	in	a	nursing	   monthly	premiums	will	range	from	$120	to	$240	for	most	enrollees.	
    home	averages	$229	nationwide.	Although	a	case	can	be	made	that	           Monthly	rates	starting	at	$5	will	be	available	to	individuals	whose	
    CLASS	was	not	designed	to	cover	the	full	cost	of	facility	care,	it	can	    income	falls	below	federal	poverty	level	and	to	employees	who	are	
    also	be	argued	that	even	home	health	care	-	which	averages	$21	an	         full-time	students	ages	18-22.
    hour	-	will	quickly	eat	up	the	daily	benefits	paid	through	CLASS.3
                                                                               Premiums	will	be	based	on	the	enrollee's	age,	and	rates	are	de-
    	       National	average	median	rates	for	long	term	care:                  signed	to
                                                                               remain	level.	However,	premiums	may	be	increased	annually	for	both	
                                                                               current	and	new	participants	to	keep	the	program	financially	sound.	
                                                                               Participants	age	65	and	above	who	have	paid	premiums	for	20	years	
                                                                               and	are	no	longer	actively	employed	are	exempt	from	rate	increases.

                                                                               Some	may	be	surprised	to	discover	that	healthy	employees	may	
                                                                               actually	find	lower	premiums	in	the	private	long-term	care	insurance	
                                                                               market,	which	also	offers	more	benefit-rich	coverage.

                                                                               5-Year Vesting Requirement
                                                                               The	CLASS	program	requires	participants	to	complete	a	five-year	
                                                                               vesting	period	before	they	may	become	eligible	for	benefits.	Enroll-
                                                                               ees	are	also	required	to	be	working	for	at	least	three	of	the	five	years.

                                                                               The	obvious	concern	with	the	program's	vesting	requirement	is	the	
                                                                               possibility	that	a	participant	will	need	care	before	completing	the	
                                                                               lengthy	vesting	period.	In	that	scenario,	the	person	would	be	
                                                                               ineligible	for	benefits.

9                                                                                                                                                          10
     In	lieu	of	a	vesting	period,	most	private	long-term	care	insurance	        Actuaries	inside	and	outside	of	government	are	concerned	about	the	
     policies	include	a	waiting	period	which	policyholders	need	to	satisfy	     risk	of	adverse	selection	-	the	attraction	of	a	disproportionate	number	
     only	once	before	collecting	benefits.	Waiting	periods,	also	called	        of	high-risk	participants,	which	can	lead	to	higher	costs	and	premi-
     elimination	periods,	typically	range	from	30	to	90	days.                   ums	-	and	the	resulting	threat	to	the	viability	of	the	program.

     Dependent Coverage                                                         Long-Term Viability
     CLASS	coverage	is	restricted	to	the	participating	company's	em-            The	CLASS	program	must	be	entirely	self-sustaining	financially	
     ployees,	and	is	not	extended	to	members	of	the	employee's	family.          through	voluntary	employee	enrollments	and	subsequent	premiums	
                                                                                paid	by	program	enrollees.	The	legislation	requires	the	program	be	
     With	this	absence	in	coverage,	CLASS	fails	to	address	one	of	the	          solvent	over	a	75-year	period	with	reports	on	the	program's	solvency	
     main	reasons	employers	choose	to	include	long-term	care	insurance	         due	annually	beginning	in	2014.
     in	their	employee	benefit	offerings:	to	reduce	employee	caregiving	
     and	the	associated	losses	in	productivity.                                 There	is	great	concern	about	the	long-term	viability	of	the	CLASS	
                                                                                program.	The	uncertainty	stems	from	factors	including	the	high	risk	of	
     Family	members	are	typically	eligible	to	enroll	in	private	long-term	      adverse	selection	and	the	difficulty	in	predicting	participation	rates.
     care	insurance	policies	at	discounted	rates	under	the	employee's	
     plan.	This	option	alleviates	the	burdens	of	family	caregiving	and	al-      If	the	program	is	determined	to	be	actuarially	insolvent	after	imple-
     lows	employees	to	maintain	productivity	on	the	job.                        mentation,	administrators	must	take	action	to	bring	it	into	a	solvent	
                                                                                state,	or	end	the	program	altogether.
     Underwriting                                                               Long-term	care	insurance	policies	in	the	private	market	are	guaran-
                                                                                teed	renewable,	meaning	the	company	cannot	cancel	coverage.	Pol-
     The	CLASS	program	offers	guaranteed	issue	coverage	based	on	a	
                                                                                icy	benefits	and	rates,	as	well	as	a	company's	actuarial	soundness	
     liberal	"actively	at	work"	requirement;	enrollees	are	not	asked	any	
                                                                                are	also	regulated	on	a	state	level.
     health	questions.	Whereas,	private	long-term	care	insurance	carriers	
     review	the	health	of	applicants	in	the	underwriting	process,	enabling	
     the	insurer	to	determine	eligibility	for	coverage	and	charge	premi-
     ums	that	are	in	line	with	the	risk.	Simplified	underwriting	may	be	
     available	with	employer	groups.

     The	absence	of	medical	underwriting	in	the	CLASS	program	is	ex-
     pected	to	be	particularly	attractive	to	people	with	pre-existing	health	
     issues	who	might	not	otherwise	qualify	for	coverage.	This	same	
     provision,	however,	is	extremely	worrisome	to	insurance	industry	

11                                                                                                                                                         12
     The	CLASS	Act,	the	government's	most	recent	reminder	of	the	need	
     for	long	term	care	planning,	is	greatly	increasing	the	attention	given	
     to	the	value	of	long-term	care	insurance.	As	a	result,	long-term	care	
     insurance	is	becoming	an	even	more	vital	component	of	employee	
     benefit	packages	to	recruit,	reward	and	retain	talented	workers.

     While	CLASS	will	be	of	value	to	employees	with	health	conditions	
     that	would	prohibit	them	from	qualifying	for	traditional	long-term	
     care	insurance,	the	majority	of	individuals	will	find	private	market	
     coverage	to	be	a	superior	alternative.

     Long-term	care	insurance	sold	through	the	private	market	offers	
     benefit-rich	policies	that	provide	adequate	coverage	for	costly	long-
     term	care	expenses.	And	when	compared	to	CLASS,	premiums	are	
     more	affordable	in	the	private	sector.	Furthermore,	one	of	the	most	
     advantageous	provisions	in	private	long	term	care	insurance	for	
     employers	is	the	option	for	employees'	family	members	to	also	pur-
     chase	discounted	coverage.	Rates	are	based	on	applicant	age	so	
     the	younger	one	is	at	enrollment,	the	lower	their	rates	will	
     always	be	when	compared	to	enrolling	at	a	later	date.

     There	are	many	things	known	about	the	CLASS	Act	program,	still	
     others	yet	to	be	determined	-	but	enough	to	know	that	the	private	
     market	will	be	a	better	alternative	for	the	healthy	and	the	CLASS	may	
     be	a	good	alternative	for	those	who	are	not.	It’s	never	too	early	to	be	
     prepared.	We	invite	you	to	learn	more	about	what	private	long-term	
     care	insurance	can	do	to	provide	peace	of	mind	today	and	financial	
     security	tomorrow,	for	you,	your	employees	and	your	company.

     1.	US	Department	of	Health	and	Human	Services,	National	Clearing	House	for	Long	
     Term	Care	Information,	October	2008
     2.	MetLife	Care	Giving	Cost	Study:	Productivity	Loss	to	US	Business,	2006
     3.	Unum	Long	Term	Care	Cost	Survey,	2008


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