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How the Plan Works
The McGraw-Hill Companies offers long-term care insurance through John Hancock Life Insurance Company. If you decide to enroll, you will choose from one of three coverage level options. The option you choose determines the "daily maximum benefit" (DMB) the plan would provide if long-term care was needed and benefits were payable.
Once enrolled, the covered person would generally be eligible for benefits when he or she
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requires substantial supervision due to a cognitive impairment, or
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becomes unable to perform without substantial assistance by another person at least two of the following "significant activities of daily living" (SADLs) due to loss of functional capacity which is expected to continue for at least 90 days:
Benefit payments do not begin immediately. There is a 90-day qualification period that starts after the individual is certified to be eligible for benefits. After being certified and completing the 90-day qualification period, benefits would be paid based on the coverage option selected at enrollment and the type and cost of care the individual was receiving.
Daily Maximum Benefit for…
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Alternate Care/ Assisted Living Facilities
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Home Health Care/ Adult Day Care
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Lifetime Maximum Benefit (equals 5 years of nursing home care)
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The plan reimburses costs of covered services up to the daily maximum benefit but does not automatically pay the full daily maximum benefit. For example, if you choose Option 1 and are receiving nursing home care, the daily maximum benefit is $100. But if the nursing home charges only $90 per day, the plan would reimburse $90, not the $100 daily maximum. The total of benefits for all charges incurred for informal care in any calendar year will not exceed 30 times the informal care daily maximum benefit.
LTC Insurance vs. Medical Coverage and Long-Term Disability (LTD) Insurance
Long-term care insurance can sometimes be confused with medical coverage and long-term disability insurance (LTD). The simplest way to separate your medical coverage and the two types of insurance plans is in the following ways:
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Your LTD insurance is meant to replace any income lost if an illness or disability causes you to miss work, while medical coverage and long-term care insurance are meant to provide money for the cost of care services.
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Your healthcare coverage covers the costs of treating an acute illness or disability.
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LTC insurance covers the costs of care needed for you to be able to perform activities of daily living.
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