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Long-Term Care (LTC) Program
Program Information>Benefits

 



The information below describes how you become eligible to receive benefits, different benefit amounts and levels that you can select, and other benefits that are included under the Long Term Care Program.

NoteThe information contained in this website applies only to new participants enrolling in the MetLife program and not transferees from the previous CNA program.

Benefit Amounts
Your benefits are calculated by the Daily Benefit Amount and the Total Lifetime Benefit that you select when you enroll in the LTC Program.

The Daily Benefit Amount (DBA) is the maximum amount of daily coverage you will receive per day for long term care services.  Any daily costs above the DBA will be the participant’s responsibility.  DBAs are dollar amounts that range from $100 to $350 in $50 increments.  

The DBA reimburses provider’s charges up to 100% of the daily benefit for nursing home, in-patient hospice care and respite services.

The DBA reimburses provider’s charges up to 75% of the daily benefit for assisted living facilities, home care, adult day care and at-home hospice care.

Your Total Lifetime Benefit (TLB) is determined by multiplying your DBA by how many years (in days) you choose for your plan.  You can select 2, 3 or 5 years for your TLB.

Example of TLB calculation:
Time = 2 Years (730 days)   DBA = $100  
730 x $100 = $73,000 TLB

Time = 3 Years (1,095 days)   DBA = $100  
1,095 x $100 = $109,500 TLB

Time = 5 Years (1,825 days)   DBA = $100 
1,825 x $100 = $182,500 TLB


MetLife offers four choices for determining your benefit amount: DBA, TLB, Nonforfeiture and Inflation Protection.  You can select one of the available DBAs and TLBs offered under the Plan, or select one of three pre-packaged plans:
 

 

Select your own Plan

Pre-Packaged Plan A

Pre-Packaged Plan B

Pre-Packaged Plan C

Daily Benefit Amount (DBA)

 $100-$350
in increments of $50

 $100/day

 $150/day

 $200/day

Total Lifetime Amount (TLA)

 2, 3, or 5 Years

 2 Years

 3 Years

 5 Years

Total Lifetime Benefit (TLB) 

 DBA times number of days in TLA

 $73,000

 $164,250

 $365,000

Optional Benefits Offered under the LTC Program

Inflation Protection
Long term care services can become more expensive over time because of inflation. There are two options offered to protect you from rising costs due to inflation:

Automatic Inflation – DBA is automatically increased by 5% compounded annually.  With this option you will pre-fund your premiums so they won’t increase as your DBA does, but your premiums will be higher.

Optional Inflation – Every three plan years you will be offered the opportunity to increase your DBA by at least 5% compounded annually.  You will be given guaranteed issue if you select this option once in every two offerings.  Premiums for your increase will be based on your attained age.

Nonforfeiture
You may elect a Nonforfeiture feature for a higher premium cost. The Nonforfeiture feature allows you to stop paying premiums at a future date and still keep a portion of your coverage. To qualify for Nonforfeiture, you must have paid premiums for at least three consecutive years. The feature provides the full DBA with a Total Lifetime Benefit based on the greater of the total amount of premium paid or 30 times the DBA. For example, if you elect the $150 DBA and pay $3,500 in premiums over three years and then decide to discontinue the policy, your Total Lifetime Benefit will be based on the greater of $3,500 (the total amount of premiums paid) or $4,500 (30 times the DBA).

Other Benefits Included Under the LTC Program

Return of Premium
If you die before the age of 65, all LTC premiums paid will be returned to your estate, minus any benefits received.  After 65, the amount of premium returned will reduce by 10% for every year until the age of 75, minus any benefits received.  This feature is not available if the insured is in the Reduced Paid-Up coverage option at the time of death.

Bed Reservation
Your bed in a nursing home in-patient hospice and assisted living facility will be reserved should you need to leave the facility, up to 30 days per calendar year.

International Benefit
If you receive your LTC services abroad and MetLife determines you are eligible to receive benefits, your benefit will be paid on a per diem basis upon completion of the waiting period. The benefit paid will be 50% of the home care DBA. The claim will be paid in U.S. dollars based on the rate of exchange at the time the claim is approved.

New York State Residents: If you are confined in a nursing home and provide proof satisfactory to MetLife of such confinement, the daily benefit will not be less than $50 per day.  Otherwise, the daily benefit will be no less than $25 per day.  This benefit will be paid up to a maximum of 6 years while the insured is outside of the United States.

Non-New York State Residents: This benefit will be paid for a maximum of 10 years while you are outside of the United States.

Alternate Plan of Service
Benefits are available for certain services not specifically covered by the plan if they are qualified and meet your needs.  A MetLife Nurse Care Manager must authorize these benefits.

Restoration of Benefits
The total lifetime benefit can be restored if certain conditions are met, such as, (i) have not received benefits for at least two years and (ii) have not exhausted your TLB and (iii) Premium payments have been made for 2 years from the date the insured was no longer chronically ill.

Transition Expense Benefit
This benefit allows you a benefit equal to 15 times your DBA to be used for LTC purposes such as a personal emergency response system, caregiver training, durable medical equipment.  Utilizing this benefit does not reduce your TLB.

Provider Discounts
Discounts with nursing homes, home health care agencies and medical equipment providers are available throughout the country. These discounts can allow your lifetime maximum
benefit to last longer. To take advantage of these discounts, contact MetLife.

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