What Is Long-Term Care? COMPANY LOGO HERE

[Pages:4]What Is Long-Term Care?

Long-Term Care (LTC) is what an individual needs when he or she requires regular assistance with day-to-day functions like bathing, eating and/or dressing or supervision due to cognitive impairment. LTC insurance helps pay for care at home, in an adult day care center, assisted living facility, nursing home or hospice -- it's your choice.

Why Long-Term Care Insurance?

With today's enhanced longevity, a growing number of Americans "live, get sick, progressively lose function, and then die."* When this happens, we not only lose the freedom to care for ourselves, we may be forced to completely deplete a lifetime of savings unless specific LTC insurance is part of our personal financial plan for protection of assets when we grow older.

*Aetna Chairman & CEO and gerontologist Dr. John W. Rowe, author of Successful Aging.

In thousands

LTC Costs Can Be Devastating National Average Costs (annual)

60

$54.9

50

40

30

$29.0

20 $13.0 $16.0 10

0

Adult Home Assisted Nursing

Care

Care Living Home

Facility

Source: GE LTC Survey, 3/02; American Council of Life Insurers, 4/00

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Where Will the Money Come From?

Long-Term Care is:

I NOT covered by your medical program.

I NOT covered by disability insurance.

I NOT covered by Medicare to any substantial degree.

I NOT covered by Medicaid unless one's assets have been reduced to the poverty level.

Did you know that an accident or illness can cause you or a family member to need longterm care at any age?

Top Ten Conditions Requiring Long-Term Care

Source: Aetna, LTC Claim History 1/02

1. Alzheimer's disease, related dementia

2. Cancer

3. Stroke

4. Parkinson's disease, other neurological conditions

5. Arthritis

6. Heart attack

7. Other injuries (fractures)

8. Emphysema, other respiratory diseases

9. Diabetes

10. Mental, nervous, other Alzheimer's related conditions

LTC96 0104

State of Ohio Aetna Group Long Term Care Insurance Benefit Summary ? Service Reimbursement Plan State of Ohio is sponsoring a group long term care insurance plan underwritten by Aetna Life Insurance Company. The chart below outlines some benefits and features of this coverage. For rates and more information, please review the Outline of Coverage document. Once you enroll for coverage, you will receive a Certificate of Coverage, which will specify in more detail the terms of this service reimbursement plan.

Who's Eligible (Eligible Class)

Enrollment Period

Spouse Discount Daily Benefit Amount = Amount of Coverage Per Day

How You Qualify for Claim (Receive Benefits)

Single Deductible/Elimination Period Premiums Waived When in Claim Expenses Covered

EMPLOYEES: All regular full-time and part-time employees of Ohio who are eligible for Ohio's health care benefits and who work at least 20 hours per week are eligible to enroll. However, if you are ill, injured or on a medical leave of absence and away from work on the date that coverage would otherwise become effective for you, then the effective date of your coverage will be delayed to the first of the month following the date you return to work for at least 5 consecutive working days in an Eligible Class. Also, if your employment status changes after you submit your enrollment form, you must notify Aetna immediately, as this may affect your eligibility for coverage. OTHER FAMILY MEMBERS: Employees' spouses, adult children/spouses (Minimum age 18), parents/in-laws, grandparents/in-laws, siblings/spouses (Minimum age 18) are also eligible to apply for coverage. Completion of a medical questionnaire and approval by Aetna is necessary before coverage becomes effective.

Active employees who enroll during a special enrollment period of 04/24/06 ? 05/12/06 may do so without providing proof of good health. New hires may enroll within 60 days of their date of hire without providing proof of good health. All other eligibles (listed above) may enroll anytime and are required to complete a medical questionnaire and be approved by Aetna before coverage becomes effective. Employees enrolling after the special enrollment period or after the new hire period may still enroll anytime, however, they will be required to complete a medical questionnaire and be approved by Aetna. There is a 10% discount in premiums if an eligible individual (employees and other eligible family members) and his/her spouse both enroll and coverage becomes effective. You choose a Daily Benefit Amount (DBA) of $100, $150, or $200 (or any amount between $60 - $300 in $1 increments). The plan will reimburse you for covered expenses incurred up to a certain percentage of your DBA (see Expenses Covered). The DBA is the maximum amount of coverage your plan could reimburse each day. (Exception: The DBA for the Assistive Equipment & Technology Benefit is the amount paid once per month). You qualify for claim when a Licensed Health Care Practitioner (LHCP) certifies that you: (1) are unable to perform at least two of six activities of daily living: bathing, dressing, eating, transferring, toileting, continence for a period of at least 90 days; or (2) have a severe cognitive impairment, like Alzheimer's. A LHCP will prescribe a Plan of Care that meets your needs. Once you qualify for claim, only one 90-day deductible/elimination period needs to be met, regardless of how often and for what reason you qualify for claim.

After the 90-day deductible/elimination period, premiums are waived. You pay no premiums while you are in claim status.

The plan will reimburse you for bills submitted for covered expenses up to a percentage of your Daily

Benefit Amount (DBA).

Facility-Based Care

Nursing Home or Hospice Facility Care

Actual Expenses up to 100% of DBA.

Assisted Living Facility Care

Actual Expenses up to 100% of DBA.

Community-Based Care Home Health Care Home Hospice Care Adult Day Care Home Modification

Assistive Equipment & Technology

Bed Reservation

Actual Expenses up to 50% of DBA. Actual Expenses up to 50% of DBA. Actual Expenses up to 50% of DBA. 100% of actual expenses up to 10 times the DBA (or $1000, whichever amount is greater). 100% of actual expenses up to 50% of DBA ? amount paid once per month. While you are receiving benefits in a covered facility and your stay is interrupted for any reason, the plan continues benefit payments if you are incurring charges to reserve a bed in such facility, up to 60 days per calendar year.

Additional benefits that do not reduce your Lifetime Maximum:

Transitional Care

One time payment equal to 3 times your DBA.

Informal Care

25% of your DBA for up to 50 days per calendar year.

Informal Caregiver Training

One payment per claim period equal to cost of training,

up to 3 times your DBA.

Respite Care

50% of your DBA for up to 21 days per calendar year

For more information, please call the LTC Hotline at 1-800-537-8521 or visit the State of Ohio LTC website at: group/stateofohio

0698194XXX_SOBTQX_SE_XX

State of Ohio Aetna Group Long Term Care Insurance Benefit Summary ? Service Reimbursement Plan State of Ohio is sponsoring a group long term care insurance plan underwritten by Aetna Life Insurance Company. The chart below outlines some benefits and features of this coverage. For rates and more information, please review the Outline of Coverage document. Once you enroll for coverage, you will receive a Certificate of Coverage, which will specify in more detail the terms of this service reimbursement plan.

Alternate Care Benefit

Lifetime Maximum Benefit Amount = Total Coverage for Life of Plan

Restoration of Benefits Future Purchase Inflation Protection Increases (to help keep pace with the rising cost of long term care)

Automatic Inflation Protection Increases (Optional) Return of Contribution (Optional)

Nonforfeiture ? Benefit Bank (Optional)

Rates and Method of Payment 30 Day Free Look Leave Job and Continue Coverage

The plan will reimburse you for bills submitted for covered expenses up to a percentage of your Daily Benefit Amount (DBA). For bills submitted for which no Long Term Care Benefit is otherwise payable under this Plan, Aetna at its discretion, may pay a benefit under the Alternate Care Benefit. The benefit amount is: Actual expenses up to the Community-Based DBA You may select a 3 or 5 year Lifetime Maximum Benefit. Your Lifetime Maximum Benefit is determined by multiplying the number of days in 3 or 5 years by your Daily Benefit Amount. The resulting dollar amount can be thought of as the pool of dollars which you can use to purchase care. Depending upon where and when you receive care, your Lifetime Maximum Benefit could be paid out in a minimum of 3 years or 5 years or a longer period of time. To determine the total amount of money that your coverage provides; i.e., Lifetime Maximum Benefit: 1. Multiply the DBA you select by 365 (days in a year). 2. Multiply that result by the number of years your plan is based on 3 or 5 years. Example of Calculating the Lifetime Maximum Benefit: DBA = $100 Lifetime Maximum Benefit is based on 5 years. Therefore, your Lifetime Maximum Benefit is: $100 x 365 = $36,500 x 5 years = $182,500.

Your Lifetime Maximum Benefit is restored by the amount paid out in benefits once you are no longer in a claim status for a period of 90 consecutive days and resume premium payments. Included in the plan: You may increase your coverage every 3 years without proof of good health. Aetna will continue to offer you this increase opportunity every 3 years, even if you declined prior offers. The only time Aetna will not make you such offers is when you are in claim and you had declined any previous offer. The amount you will be able to purchase is $1 up to 5% per year of your current DBA the Plan Maximum DBA compounded annually for the previous 3 years. When you purchase more coverage, you will pay additional premium at a rate based on your age as of the date Aetna receives your request for the increased coverage amount.

Alternative to Future Purchase Inflation Protection: You may choose the Automatic Compound Inflation Option which will automatically increase your Daily Benefit Amount every year on an annual compounded basis. Please check the Rates in the last section of the Outline of Coverage for additional cost.

If you die, even while in claim, a named beneficiary will receive 100% of premiums you have paid for LTC coverage. However, the following rules apply: - The amount of the refund/return is reduced by 10% starting at age 65; and - The amount of the refund/return is further reduced by the amount of benefits paid out. No Refund of Contributions is paid if you have stopped paying premium, except if you are on premium waiver. Please check the Rates in the last section of the Outline of Coverage for additional cost. If you stop paying premium within the first three years of your Long Term Care (LTC) coverage effective date, all premium and benefits are forfeited. However, if you stop paying premium after your LTC coverage has been in effect for three or more years, Aetna will hold a benefit for you. Your Daily Benefit Amount (DBA) will stay the same, however, your new Lifetime Maximum will be the greater of: (1) 100% of premiums paid, or (2) one month of benefits (30 times your DBA). Please check the Rates in the last section of the Outline of Coverage for additional cost. Rates are included in the last section of the Outline of Coverage. Employees'/spouses' premiums are payroll deducted. All others are billed directly by Aetna. Your premiums will be refunded if you cancel your plan within 30 days of receiving your Certificate of Coverage. If you leave your current employer, you can continue your coverage at the same group rate by paying premiums directly to Aetna.

For more information, please call the LTC Hotline at 1-800-537-8521 or visit the State of Ohio LTC website at: group/stateofohio

0698194XXX_SOBTQX_SE_XX

State of Ohio Long Term Care Monthly Premiums ? Service Model Plan,

3-Year Lifetime Maximum

(No optional benefits included)

AGE 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54

3-Year Lifetime Maximum

$100 DBA $109,500 Lifetime Maximum

$150 DBA $164,250 Lifetime Maximum

$200 DBA $219,000 Lifetime Maximum

$2.60

$3.90

$5.20

$2.70

$4.05

$5.40

$2.90

$4.35

$5.80

$3.00

$4.50

$6.00

$3.20

$4.80

$6.40

$3.40

$5.10

$6.80

$3.70

$5.55

$7.40

$4.10

$6.15

$8.20

$4.40

$6.60

$8.80

$4.80

$7.20

$9.60

$5.30

$7.95

$10.60

$5.70

$8.55

$11.40

$6.20

$9.30

$12.40

$6.70

$10.05

$13.40

$7.20

$10.80

$14.40

$7.80

$11.70

$15.60

$8.40

$12.60

$16.80

$8.90

$13.35

$17.80

$9.50

$14.25

$19.00

$10.10

$15.15

$20.20

$10.70

$16.05

$21.40

$11.50

$17.25

$23.00

$12.20

$18.30

$24.40

$13.00

$19.50

$26.00

$13.70

$20.55

$27.40

$14.50

$21.75

$29.00

$15.40

$23.10

$30.80

$16.30

$24.45

$32.60

$17.50

$26.25

$35.00

$18.70

$28.05

$37.40

$20.00

$30.00

$40.00

$21.30

$31.95

$42.60

$22.80

$34.20

$45.60

$24.80

$37.20

$49.60

$27.00

$40.50

$54.00

AGE 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90+

3-Year Lifetime Maximum

$100 DBA $109,500 Lifetime Maximum

$150 DBA $164,250 Lifetime Maximum

$200 DBA $219,000 Lifetime Maximum

$29.40

$44.10

$58.80

$32.10

$48.15

$64.20

$35.20

$52.80

$70.40

$38.40

$57.60

$76.80

$42.20

$63.30

$84.40

$46.10

$69.15

$92.20

$50.80

$76.20

$101.60

$55.80

$83.70

$111.60

$61.80

$92.70

$123.60

$68.30

$102.45

$136.60

$74.40

$111.60

$148.80

$82.10

$123.15

$164.20

$91.30

$136.95

$182.60

$98.80

$148.20

$197.60

$107.20

$160.80

$214.40

$116.60

$174.90

$233.20

$127.10

$190.65

$254.20

$139.00

$208.50

$278.00

$152.20

$228.30

$304.40

$167.00

$250.50

$334.00

$183.40

$275.10

$366.80

$201.90

$302.85

$403.80

$222.70

$334.05

$445.40

$245.70

$368.55

$491.40

$270.30

$405.45

$540.60

$295.40

$443.10

$590.80

$318.80

$478.20

$637.60

$341.60

$512.40

$683.20

$365.10

$547.65

$730.20

$386.40

$579.60

$772.80

$404.80

$607.20

$809.60

$425.80

$638.70

$851.60

$443.80

$665.70

$887.60

$459.20

$688.80

$918.40

$472.70

$709.05

$945.40

$482.10

$723.15

$964.20

To Calculate Premium Cost: 1. Find the rate associated with your age on the chart above. 2. Multiply that amount by 12 months to determine your annual premium. 3. Divide that number by the number of payments per year to determine your premium per payment.

Aetna will bill any enrolled member directly to the address provided at time of enrollment.

For additional rates and information please visit: group/stateofohio or call an Aetna LTC Representative at: 1-800-537-8521.

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