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    Long Term Care Insurance Plan
        The Plan at a Glance
        Participating in the Plan
       
How the Plan Works
         About Your Benefits
        What Is Not Covered
        Filing a Claim
        Glossary
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How the Plan Works
This plan helps pay for the care you or a covered family member require as a result of an illness, an accident, or age. This care may be needed for a lengthy period of time, either in your home or in a facility that provides long-term care.
In the event of a conflict among the terms in this Summary Plan Description and the Certificate of Coverage, the Certificate of Coverage will govern. You will receive a Certificate of Coverage from MetLife within 30 days after you are enrolled in the Plan.
What is long-term care?
Long-term care refers to the services and assistance you or a family member could need as a result of an illness, an accident, or age.
This care may be needed when someone becomes unable to care for himself or herself and requires help doing everyday activities like dressing, eating, bathing, continence, toileting and transferring. Just as it sounds, long-term care is about needing care for a lengthy period of time, either in your home or in a facility that provides long-term care services.
If I am on an authorized unpaid leave of absence or am disabled, does the Plan still provide a benefit?
You will be able to continue paying for your coverage, at your current premium, on a direct bill basis with MetLife. You should contact MetLife to see if you qualify to collect Long Term Care Benefits.
Can I name a beneficiary under this Plan?
No, you cannot name a beneficiary under this plan. If you die before age 75, MetLife will return all or a portion of your premiums paid into the plan (the amount depends on your age at death and amount of benefits received, if any) to your estate.
How do I or my covered family member qualify for benefits; is there a "waiting period"?
To qualify for benefits, you or your covered family member must be certified by a licensed health-care practitioner as being unable to perform at least two of the six Activities of Daily Living (bathing, continence, dressing, eating, toileting, transference) for a period (also know as the "waiting period") of at least 90 days, or as requiring substantial protective supervision due to severe cognitive impairment.
When will I or my covered family members be qualified to receive long-term care?
You or your covered family member must be certified as chronically ill.
Can I choose where to receive my care?
Yes, you can choose where to receive care, in conjunction with your case manager.
Initial Care Planning Visit
Can I receive help in making my decisions on what kind of care to receive?
Yes. Independent care advisors are available to meet with you and your family in your home or another location to explore care options and help you make decisions. Offered at no charge, this one-time service is initiated at your request after you qualify for benefits.
There is a limit of $250 for this visit. Residents of Texas will have a limit of $275 for this visit.
Care Management
What is the role of care management?
You need to contact MetLife to develop a plan of care when you require long-term care services. MetLife will monitor your care to make sure you are receiving the best care, in their judgment, to meet your needs.
You can also contact MetLife for a recommendation and approval of alternative benefits.
Do I have to use care management?
Yes, you need to contact MetLife to develop a plan of care when you require long-term care. MetLife will monitor your case to make sure you are receiving the best care, in their judgment, to meet your needs.
When do I need to contact MetLife regarding care management?
You may contact MetLife at any time. You should contact MetLife as soon as you learn that you need long-term care services.
 
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