Long-Term Care Voluntary Insurance Program Frequently Asked Questions

Q. Are the benefit eligibility guidelines (assistance with at least 2 of 6 activities of daily living or a severe cognitive impairment either of which are expected to last for a minimum of 90 days) for the long-term care (LTC) program the same as Medicare?
A. No, Medicare guidelines are based on medical necessity, which differs from the guidelines described above.

Q. Would a previous war-related injury be considered an exclusion from coverage?
A. Yes, if the sole reason for needing LTC benefits was from an injury resulting from an act of war it would be considered an exclusion. Benefits would not be paid. War is defined as the armed action of a sovereign nation against another sovereign nation.

Q. Are step-parents and step-grandparents part of the group eligible for LTC?
A. Yes, stepparents, step-parents-in-law, step-grandparents and step-grandparents-in-law are all part of the eligible group.

Q. Would an at-home hospice caregiver be covered if he/she was not licensed with an agency?
A. Typically hospice providers are licensed to provide care at a hospice. MetLife will cover a non-licensed at-home hospice caregiver as long as the caregiver is referred by a licensed agency.

Q. What are the average nursing home costs by state?
A. For more information, see the 2003 MetLife Market Survey of Nursing Home & Home Care Costs (PDF) which provides average nursing home and home care costs.

Q. What is the average annual increase in nursing home costs - relative to the MetLife automatic inflation option that increases benefits and the lifetime maximum by 5 percent compounded annually?
A. Nursing home and adult day care costs average an increase of 4.25 percent per year, as indicated by MetLife's Mature Market Institute. Nursing home inflation has averaged 4.25 percent over the past four years, according to the U.S. Bureau of Labor Statistic's Consumer Price Index (CPI) for nursing homes and adult day care. This index has only been tracked over the past four years, and there is no CPI for home health care. (Long-term Care: An Industry in Transition Fitch IBCA, Duff & Phelps, January 18, 2002)

Q. Are there any tax benefits to the long-term care program?
A. This program is tax-qualified. Premiums deducted from payroll are an after-tax deduction. A portion of the premiums may be considered federally tax-deductible if the long-term care premiums combined with any other unreimbursed medical expenses exceed 7.5 percent of the insured's adjusted gross income. Benefits received from a long-term care program are generally not considered taxable income for federal income tax purposes. MetLife recommends that an insured consult with their tax advisor for further details.

NOTE: These materials provide general information about the MetLife long-term care voluntary insurance program. In the event of any conflict between these materials and the terms and conditions of the relevant plan documents, the plan documents will govern.

These are voluntary programs that American Standard makes available to its employees through
Marsh @WorkSolutions. American Standard does not sponsor, contribute to, or endorse, any service or policy offered under the program. American Standard's responsibility under PersonalPlans will be limited to coordinating payroll deductions for premium payments. If you choose to purchase a service or policy or policies under PersonalPlans, your contract for coverages will be with each insurance provider, and your contact for policy servicing will be Marsh @WorkSolution.

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