When will my policy be effective?
All employee policies will be effective on 1/1/2025.
What is Universal Life Insurance with Long Term Care (LTC) benefits and what does it cover?
Universal Life Insurance with a Long Term Care rider is permanent Life Insurance (not term insurance) that combines the benefits of both Life Insurance protection for your family along with living benefits, which can be utilized to help pay for long term care 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.
What is the difference between Long Term Care and Long Term Disability insurance?
Long Term Care benefits 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.
Why does the application require my SSN, height, and weight?
The insurance company requires SSN to set up the policy as it is used for tax purposes and claims. Height and weight are used in underwriting if you are ineligible for Guarantee Issue underwriting and are required to answer health questions.
Can I add my spouse or domestic partner?
Yes, spouses and domestic partners are eligible to apply. If your spouse/domestic partner also works for this employer they should apply as an “employee”, to qualify for Guarantee Issue underwriting (no health questions). Guarantee issue is available for employees age 18-64.
How does this universal Life Insurance with Long Term Care (LTC) work?
- Applicants ages 18-64 will be issued universal Life Insurance that provides a higher death benefit during your working years, when your needs, responsibilities and expenses are at their greatest. When you turn 70 or after 15 years (whichever is later), the death benefit reduces to 1/3 your original amount.
- This policy also includes a Long Term Care benefit that can help you pay for LTC services in your home and/or a facility at any age. This LTC benefit never reduces due to age, so the full amount is always available when you most need it.
- Applicants ages 65-70 will be issued a standard universal Life Insurance policy, where the death benefit will remain unchanged and will not reduce to 1/3 of the original death benefit at age 70.
- Applicants ages 71-75 will be issued a standard universal Life Insurance policy which will NOT include LTC coverage. The death benefit will remain unchanged and will not reduce to 1/3 of the original death benefit.
What if I am over the age of 70, is there a LTC benefit available to me?
Please contact AGIS Network for assistance in exploring available options. Phone: 1-877-485-2318 or Email: [email protected]
How much universal Life Insurance can I purchase and how is my monthly Long Term Care benefit calculated?
- The policy options for employees and spouses/domestic partners are $10,000 up to $300,000 (in $25,000 increments).
- 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 25 months. For example, a $50,000 policy provides a $2,000 monthly LTC benefit. A $300,000 policy provides a $12,000 monthly LTC benefit.
- Note: LTC is not available for applicant ages 71 to 75.
This policy provides 25 months of long term care benefits. After receiving benefits for 25 months, is it possible for the policy to pay additional long term care benefits?
Yes, this policy extends long term care benefits up to 25 months, allowing the insured to receive long term care benefits for a total of up to 50 months.
When I start receiving LTC benefits, does the death benefit decrease as each monthly LTC benefit is paid out?
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. 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 out.
Does the plan provide a way to “replenish” or restore my death benefit as LTC benefits are paid?
- Yes, it includes a monthly dollar-for-dollar restoration of the death benefit as each monthly LTC benefit is paid out. Here is how it works. A $50,000 policy provides a $2,000 monthly LTC benefit. After the first monthly LTC benefit is paid, the net death benefit would be reduced to $48,000 - only to be restored back to the original $50,000 death benefit.
- The Pfizer plan has Extension of Benefits which means, with a $50,000 policy you can receive up to $100,000 in LTC benefits +$50,000 of deaths benefits for a total maximum benefit of $150,000.
How is my rate determined?
This insurance offers unisex rates based on your age as of the policy effective date, tobacco usage (cigarettes only) and coverage selected.
Can I pay the monthly premium with a credit card?
No. The premiums must be paid with a checking or savings account.
When will my first premium payment occur?
Your first premium payment via bank draft will be 1/15/2025.
Are the premiums pre-tax or post-tax?
The premiums are paid post tax.
Do premiums continue when on LTC claim?
The plan has Waiver of Premium, which means that while you receive LTC benefits, all premiums are waived.
What if I cancel my plan outside of the 30-Day Free Look Period? Do I get my money back?
If an insured cancels the policy after the 30-Day Free Look Period, they will receive any Cash Value minus any applicable policy surrender fees.
What are the questions employee need to answer for underwriting?
employee Guaranteed Issue - No Health Questions!
Ages 18-64
Hired between 10/1/2023 – 9/30/2024
Policy options: $10,000 up to $200,000 (in $25,000 increments)
employee Simplified Issue – will include health questions
Ages 18-64 - Any amount > than $200,000 up to $300,000
Ages 65-75 - Any amount up to $300,000
Late entrants hired before 10/1/2023
- Is any person to be insured now disabled, been seen by a physician, or treated in a medical facility, including a doctor’s office, within the last 6 months for illness or disease (other than flu and colds)?
- Has any person to be insured been treated for, or diagnosed by a member of the medical profession as having, Acquired Immune Deficiency Syndrome (AIDS) or tested positive on an AIDS or HIV test?
- Has any person to be insured:
- Had, within the past 5 years: heart disease; chest pains, high blood pressure; stroke; diabetes; cancer; tumor; kidney disease; blood disorder (excluding any testing for HIV antibodies); liver disease; lung disease; or other known health impairments?
- Within the past 10 years received medical treatment or counseling, or participated in a rehabilitation program, for alcohol or drug abuse?
- Seen a medical practitioner in the past 12 months for anything other than a routine physical exam?
NOTE: employee ages 18-64 that are declined by simplified underwriting, will still be eligible for the Guarantee Issue maximum amount.
If I answer “Yes” to any Simplified Issue health questions, will I be declined coverage?
A “Yes” answer to any of the health questions will NOT preclude the applicant from continuing the application process.
Can I increase my universal Life Insurance policy at a later date?
For additional coverage, you can purchase a second universal life policy, rates for this additional coverage request will be based on your current age.
If I choose to increase my existing universal life insurance policy, will I have to answer health questions?
Insureds who request to increase their existing policy will be issued a second universal life insurance policy equal to the amount of additional life insurance requested. Employees ages 18-64 can increase their existing policy without answering health questions provided the cumulative life insurance total of the two polices does not exceed $200,000. Employees age 65 and older, as well as spouses, children and grandchildren will be required to answer health questions for any increase requested.
What are the LTC Benefit Triggers with the plan?
- You become eligible for Long Term Care benefits once you have satisfied the 90 Day Elimination Period, your physician has submitted a Plan of Care stating LTC services are medically necessary and certifies that you require assistance with at least two of the Activities of Daily Living (ADLs) or have a Cognitive Impairment.
- To satisfy the Elimination Period, 90 days of LTC services must be rendered within six (6) months or else a new 90 Day Elimination Period begins.
- Activities of Daily Living (ADLs) are Eating, Dressing, Bathing, Going to the Toilet, Continence, and Transferring. Note: Under the plan, Cognitive Impairment can be the only benefit trigger needed for benefits to begin to pay. This is extremely important because most people with Alzheimer’s or Dementia can still bathe, dress, and feed themselves but need supervision and might need to be in a facility.
How does the plan pay LTC benefits?
Long Term Care Facility and Assisted Living Facility Benefit:Home Health Care and Adult Day Care Benefit:
- Once eligible for LTC benefits, the insurance company will pay the Long Term Care facility or the assisted living benefit for each month the insured remains confined in a Long Term Care or assisted living facility, following the Elimination Period, for up to 25 months for all Benefit Periods combined. For a partial month of confinement, benefits are payable on a pro-rata basis; One thirtieth (1/30) of the monthly benefit will be paid for each 24-hour day of confinement. If a new confinement is within the same Benefit Period as a previous confinement, benefits are resumed at the previous amount of monthly benefit.
- The insurance company will pay a benefit for home health care or adult day care for each month the insured receives such care, following the Elimination Period, for up to 25 months for all Benefit Periods combined. Benefits are payable on a pro-rata basis. One thirtieth (1/30) of the monthly benefit will be paid for each day of home health care or adult day care.
Can the plan provide LTC benefits for care provided by unlicensed/informal caregivers such as family or friends?
No. Care must be provided by licensed professional providers.
Where does the plan pay for care?
If you qualify for LTC benefits, where you receive care is up to you (at home, assisted living, adult day care, nursing home).
Will the plan pay for care outside of the US?
The universal Life Insurance policy will only pay LTC benefits for care received in the United States or Canada. Death benefits are paid anywhere in the world.
Are my LTC benefits taxable?
Benefits paid may or may not be taxable. Whether or not You or Your Beneficiary incur a tax liability when benefits are paid depends on how the IRS interprets applicable portions of the Tax Code. As with all tax matters, you should consult Your personal tax advisor to assess the impact of this benefit. The insurance company has no responsibility for any tax consequences of any benefits paid under this policy. The rider for long-term care insurance is not intended to be a federally qualified long-term care insurance contract.