Welcome To The Alera Group Long-Term Care Solution

This coverage combines the benefits of both Life Insurance protection for your family along with Long-Term Care benefits, which can be utilized to help pay for services such as home healthcare, adult day care, assisted living facilities and nursing home expenses. Long-Term Care is personal care - help with everyday activities such as bathing and dressing (also known as "Activities of Daily Living”) and/or care for severe cognitive impairments like Alzheimer’s Disease.

Long-Term Care insurance helps cover the cost of a nursing home, assisted living, adult day care or home health care if you become unable to care for yourself. Long Term Disability insurance replaces a portion of the income you will lose if you are unable to work because of an injury or illness. It pays for your lost income. Unlike disability insurance, Long-Term Care insurance does not end when one retires – it remains active into retirement, provided premiums are paid.

The insurance company requires social security number to set up your coverage for tax purposes and claims. Height and weight are needed only when applicants are required to answer the Simplified Issue health questions.

Yes, spouses/domestic partners are eligible if the employee applies for coverage. If the employee does not apply for coverage, the spouse is ineligible. Spouse/domestic partner coverage is limited to no more than 50% of the coverage amount elected by the employee, up to a maximum of $75,000.

If your spouse/domestic partner also works for this employer, they should apply for coverage as an “employee” (not as a spouse) to qualify for Guarantee Issue underwriting (no health questions).

The employee Life Insurance options are $20,000, $40,000, $50,000, $75,000, $100,000, $125,000, and $150,000.

The monthly Long-Term Care benefit is 4% of the death benefit and can be used for homecare and/or facility care for up to 75 months. For example, a $50,000 policy provides a $2,000 monthly Long-Term Care benefit up to $150,000 in total Long-Term Care benefits.

Your death benefit is guaranteed when it is needed the most – during the working years when a family is relying on income. The death benefit is 100% guaranteed for the longer of 25 years or age 70. Any reduction in death benefit (after age 70 or 25 years, the longer of) will result in a corresponding decrease in the monthly Long-Term Care benefit.

This is permanent Life Insurance designed to last a lifetime. Should you leave your employer or retire, you can keep your coverage at the same cost and benefit levels.

Yes, the death benefit is accelerated (reduced) to pay each monthly LTC benefit. For example, a $50,000 policy provides a $2,000 monthly LTC benefit, so after the first monthly LTC benefit is paid, the net death benefit would be $48,000. This depletion of the death benefit continues as LTC benefits are paid.

Yes, all coverage includes 50% Restoration of Death Benefits. Once the death benefit falls below 50% of its original value, it is restored to 50% of its original value up to a maximum of $50,000.

For Example: $100,000 in coverage would pay $4,000 per month in LTC benefits ($100,000 x 4%). If the insured received $24,000 or 6 months of LTC benefits ($4,000 per month x 6 months = $24,000), the net death benefit would be $76,000. If the insured then died, $76,000 in Life Insurance proceeds would be paid to the beneficiary. Alternatively, if the insured had received $52,000 or 13 months of LTC benefits ($4,000 per month x 13 months = $52,000), the death benefit would be restored to 50% of its value or $50,000. If the insured were to die, the policy would pay $50,000 in Life Insurance benefits.

*Not available in CA and PA

This insurance offers unisex rates based on your age (as of the effective date), nicotine usage, and coverage level selected.

Your premiums will be paid monthly via payroll deduction.

The premiums are paid post tax.

The plan has Waiver of Premium, which means that while you are receiving LTC benefits, all premiums are waived.

The Certificate holder may, within 30 days after the Certificate is delivered, return the Certificate to the Carrier’s Administrative Office, and receive a full refund of any premiums that have been paid. Once returned, the Certificate will be void from the effective date.

Life Insurance premiums are guaranteed and cannot increase. LTC rates are subject to change.

Employee Guaranteed Issue (No Health Questions)

Guarantee Issue is available for employees ages 19 through 70. Employee Guarantee Issue Limits are $20,000 up to $150,000. There is just one “Actively at Work” question (below).

“Is the employee actively at work performing the regular duties of the job in the usual manner and at the usual place of employment?”

Employees who answer “No” to the above Actively at Work question are ineligible to enroll but may apply for coverage upon their return to work and during the next enrollment period.

Employee Simplified Issue

Employee Simplified Issue is available for employees ages 71 through 80. The Simplified Issue Limit is $50,000.

Employee Simplified Issue Health Questions

Has the Employee missed more than 5 consecutive days of active work due to an illness or injury in the past 3 months?

Has any proposed Insured been treated in a medical facility, hospitalized, or disabled in the past 6 months, excluding flu or cold? Hospitalized means in-patient or outpatient, whether or not confined. Treated in a medical facility does NOT include a regular physician’s office visit.

Has any Proposed Insured, within the last 10 years, been tested positive for exposure to the Human Immunodeficiency Virus (HIV) infection, been diagnosed by a physician as having Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) caused by the HIV or other sickness, or condition derived from such infection?

Note: Employees who answer “Yes” to the above HIV/AIDS question are ineligible for coverage.

Has any person/Spouse proposed for coverage been seen or treated by a licensed physician or other medical practitioner within the past 6 months, excluding flu, cold or routine physical?

Height: Weight:

Within the past 5 years, has any proposed Insured been admitted or advised to be admitted to a hospital or received medical advice or treatment by a licensed member of the medical profession for: Inquiries are specific as to treatment or diagnosis as provided by a licensed health care practitioner.

Any chest pain, heart disease, stroke or paralysis, lung or respiratory disease, blood disease or high blood pressure? If yes, provide most recent blood pressure reading and date.

Any cancer, tumor, disorder of the kidney, liver disease or hepatitis?

Any mental or psychiatric disorder, stomach or intestinal disorder or reproductive organ disorder?

Received or been advised to have, by a licensed member of the medical profession, counseling, or treatment for the use of alcohol, drugs, illegal drugs, or used any illegal drug or controlled substance?

Taken any prescription medication in the past 6 months (If “Yes”, state name of medication, reason for taking frequency and dosage)?

Had or been advised to have, by a licensed member of the medical profession, an electrocardiogram, x-ray, blood study, urinalysis, or any other diagnostic study, operation, or treatment?

Other than stated above, within the past 5 years, had any other illness, operation, or treatment?

Guarantee Issue (no health questions) is available for spouses/domestic partners ages 19 through 60. Spouse Guarantee Issue Limits are the lesser of 50% of the employee amount or $20,000. For example, if the employee applies for $20,000, the maximum Guarantee Issue amount the spouse could apply for would be $10,000.

Spouse Conditional Guarantee Issue

Conditional Guarantee Issue (some health questions) is available for spouses/domestic partners ages 19 through 70. Spouse/domestic partner Conditional Guarantee Issue Limits are 50% of the employee amount up to $75,000.

For spouses/domestic partners ages 19 through 60 who apply for amounts of $20,001 up to $75,000, the Conditional Guarantee Issue health questions are required.

Spouse Conditional Guarantee Issue Health Questions

Has any proposed Insured been treated in a medical facility, hospitalized or disabled in the past 6 months, excluding flu or cold? Hospitalized means in-patient or outpatient, whether or not confined. Treated in a medical facility does NOT include a regular physician’s office visit.

Has any Proposed Insured, within the last 10 years, been tested positive for exposure to the Human Immunodeficiency Virus (HIV) infection, been diagnosed by a physician as having Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) caused by the HIV or other sickness, or condition derived from such infection?

Note: Applicants who answer “Yes” to the above HIV/AIDS question are ineligible for coverage.

Has any person/Spouse proposed for coverage been seen or treated by a licensed physician or other medical practitioner within the past 6 months, excluding flu, cold or routine physical?

NOTE: Spouse/domestic partners who answer “Yes” to any Conditional Guarantee Issue questions (excluding the HIV/AIDS question) are required to answer the Simplified Issue health questions (below).

Spouse/Domestic Partners Simplified Issue Health Questions:

Height: Weight:

Within the past 5 years, has any proposed Insured been admitted or advised to be admitted to a hospital or received medical advice or treatment by a licensed member of the medical profession for: Inquiries are specific as to treatment or diagnosis as provided by a licensed health care practitioner.

Any chest pain, heart disease, stroke or paralysis, lung or respiratory disease, blood disease or high blood pressure? If yes, provide most recent blood pressure reading and date?

Any cancer, tumor, disorder of the kidney, liver disease or hepatitis?

Any mental or psychiatric disorder, stomach or intestinal disorder or reproductive organ disorder?

Received or been advised to have, by a licensed member of the medical profession, counseling or treatment for the use of alcohol, drugs, illegal drugs, or used any illegal drug or controlled substance?

Taken any prescription medication in the past 6 months (If “Yes”, state name of medication, reason for taking frequency and dosage)?

Had or been advised to have, by a licensed member of the medical profession, an electrocardiogram, x-ray, blood study, urinalysis, or any other diagnostic study, operation, or treatment?

Other than stated above, within the past 5 years, had any other illness, operation, or treatment?

Employees who answer “No” to the “Actively at Work” Guarantee Issue question will be ineligible for coverage but may enroll for coverage upon return to work and during the next enrollment period. Applicants who answer “Yes” to the HIV/AIDS will be ineligible for coverage.

You can request to increase your coverage later with Simplified Issue underwriting. If approved, you will be issued a second Life Insurance policy based on your current (attained) age.

The Certificate holder may, within 30 days after the Certificate is delivered, return the Certificate to the Carrier’s Administrative Office, and receive a full refund of any premiums that have been paid. Once returned, the Certificate will be void from its beginning.

Means the number of days at the beginning of a Period of Care for which benefits are not payable under this Rider. In order for a day to count as a day in the Elimination Period, the following requirements must be met:

• The Insured must be Chronically Ill; and
• Charges must be incurred for the care and services of the Insured.

The elimination period needs to be satisfied only once during the Insured’s lifetime.

You must satisfy the Elimination Period before benefits are paid. Each day the Insured is Chronically Ill, and charges are incurred for the care and service of the insured, one day of the Elimination Period will be satisfied.

Chronically Ill means certified by Licensed Health Care Practitioner as:

• being unable to perform, without substantial assistance from another individual, at least 2 Activities of Daily Living (ADLs) for at least 90 days due to a loss of functional capacity or
• requiring substantial supervision for protection from threats to health and safety due to Severe Cognitive Impairment.

Activities of Daily Living (ADLs) include: Bathing, Dressing, Continence, Eating, Toileting and Transferring

Care must be provided by licensed professional providers.

If you qualify for LTC benefits, where you receive care is up to you (e.g., Home Care, Assisted Living/Memory Care, Adult Day Care or Skilled Nursing Homes).

The plan will pay LTC benefits for care or services received in the United States or its territories only. Death benefits are paid anywhere in the world.

If the insured commits suicide, while sane or insane, within two years (one year in some states) from the Date of Issue, and while this Coverage is in force, the Carrier will pay in one sum to the Beneficiary, the amount of premiums paid for this Coverage.

The Carrier will not pay Long-Term Care benefits for care that is received, or loss incurred as a result of:

• Any Pre-Existing Conditions; See Pre-Existing Condition Limitation noted below;
• Mental or nervous condirtions except Alzheimer’s Disease;
• Alcoholism and drug addiction;
• Illness, treatment or medical conditions arising out of:
  • War or act of war (whether declared or undeclared);
  • Participation in a felony, riot or insurrection;
  • Service in the armed forces or units auxiliary thereto;
  • Suicide (sane or insane), attempted suicide, or intentionally self-inflicted injury;
  • or Aviation (non-fare-paying passengers);
• Treatment provided in a government facility (unless otherwise required by law), services for which benefits are available under Medicare or other Governmental program (except Medicaid), any state or federal workers’ compensation, employers’ liability or occupational disease law, or any motor vehicle no-fault law, services provided by a member of the covered person’s immediate family, and services for which no charge is normally made in the absence of insurance.
• Expenses for services or items available or paid under another Long-Term Care insurance or health insurance policy.
• In the case of a Long-Term Care contract, expenses for services or items to the extent that the expenses are reimbursable under Title XVIII of the Social Security Act or would be so reimbursable but for the application of a deductible or coinsurance amount; or
• Care or services received outside the United States or its territories.

LTC benefits are not payable for care received in the first 6 months after the coverage issue date if a Pre-Existing Condition causes an insured to be Chronically Ill. Care received 6 months or more after the issue date caused by a Pre-Existing Condition will be covered.

LPre-Existing Conditions means a condition for which medical advice or treatment was recommended by or received from a provider of health care services within 6 months preceding the date of issue.