Long-Term Care Plan

Plan Participation

Participation in the Long-Term Care Insurance Plan was open to eligible Tufts Health Plan employees who enrolled in the Plan before December 31, 2011. This Plan Participation description applies to you only if you enrolled in the Plan before that date. 

DEPENDENT COVERAGE
If you enrolled in the LTC Plan before December 31, 2011, your eligible dependent(s) became eligible to apply for LTC Plan coverage on the same date that you became eligible. In order to qualify for coverage, an eligible dependent must have been between the ages of 18 and 84.

Your eligible dependents included: 

  • your spouse or domestic partner
  • your parents and parents-in-law
  • your grandparents and grandparents-in-law
  • your siblings and their spouses
  • siblings of your spouse or domestic partner
  • your adult children (age 18 or over) and their spouses 

Definition of “Spouse”: For plan purposes, your spouse is your wife or husband who is not divorced or legally separated from you. 

Definition of “Children”: For plan purposes, your children are your natural, adoptive, or stepchildren who are 18 years of age or older. 

Definition of “Domestic Partner”: For plan purposes, a domestic partner is a person of the same or opposite sex whose domestic partnership with you is currently registered with a governmental body pursuant to state or local law.

If not currently registered with a governmental body, a qualifying domestic partner also includes a person of the same or opposite sex with whom you have provided the Company a signed affidavit certifying, under penalty of perjury, that you and that person: 

  • have chosen to share one another’s lives in an intimate and committed relationship of mutual caring; and
  • share your regular and permanent residence; and
  • are both at least eighteen (18) years of age; and
  • are not married to anyone else, nor are either of you a member of another domestic partnership with someone else that has not been terminated, dissolved or adjudged a nullity; and
  • are not related by blood closer than would bar marriage; and
  • are financially interdependent; and
  • have not had a different domestic partner in the last twelve (12) months, excluding other domestic partnerships that have terminated due to death, court order, or pursuant to state or local law.          

Valid written proof of the establishment of a domestic partnership must be placed on file with the Company. (Valid written proof of a domestic partnership includes a copy of the registration or the Affidavit of Domestic Partnership, and proof of financial interdependence.) The Company must provide approval of the partnership to you and to the Insurance Company. 

WHEN YOUR COVERAGE BEGAN
If you enrolled in the LTC Plan within 31 days of the date that you were hired (and before December 31, 2011), coverage for you and your eligible dependents began as of the first day of the month following the date on which the Insurance Company: 

  • approved your application for coverage; and
  • received your first payroll deduction contribution (within 31 days of the date that it was due). 

COVERAGE LEVELS
If you enrolled in the LTC Plan before December 31, 2011, you were eligible to choose one of the following levels of dependent coverage for your Plan benefits: 

  • Employee only; or
  • Employee and spouse/domestic partner. 

Other eligible dependents (for example, your children, parents, grandparents, or siblings) must apply for LTC Plan coverage on an individual basis. 

PAYING FOR YOUR BENEFITS
If you are currently enrolled in the LTC Plan, you pay the cost of your coverage through convenient before-tax payroll deduction contributions. The cost to you depends on the level of dependent coverage and benefit payment options you selected. This is explained under "LTC Plan Benefit Options" in the How Your Long-Term Care Insurance (LTC) Plan Works section. 

Your payroll deduction contributions come out of your pay before federal and (in most cases) state and local taxes are deducted, so they will reduce your taxable income.

Note: Your payroll deduction contributions may include coverage for yourself or yourself and your spouse/domestic partner (as defined in the "Coverage Levels" section below). Other eligible dependents (for example, your children, parents, grandparents, or siblings) must pay their LTC Plan premiums on an individual basis. 

CHANGING OR CANCELING YOUR COVERAGE
If you are currently enrolled in the LTC Plan, you or another covered person can cancel your Plan coverage at any time. 

Changing Your Coverage
Mid-year election changes (e.g., increasing or decreasing the amount of your LTC Plan coverage during the year) are permitted under certain circumstances. You should contact the Insurance Company at 1-800-711-9407 if you want to change your current coverage amount.

LAYOFF OR LEAVE OF ABSENCE
If you are currently enrolled in the LTC Plan, you may elect to continue your Plan coverage during a temporary leave of absence for non-FMLA* reasons. If you are in an unpaid status or receiving disability pay: 

  • the contributions you would otherwise have paid towards the cost of your coverage must be paid by personal check to John Hancock during your temporary leave period; and
  • Tufts Health Plan will notify John Hancock of your leave status and you will be transferred to direct billing. 

Your LTC Plan payroll deduction contributions will resume when you return to paid status. 

You should contact Human Resources for more information concerning the continuation of your coverage during a layoff or leave of absence. 

Family and Medical (FMLA*) Leave: If you are currently enrolled in the LTC Plan, you may elect to continue your Plan coverage during an authorized Family and Medical (FMLA) leave of absence. If you are in an unpaid status or receiving disability pay, the contributions you would otherwise have paid towards the cost of your coverage must be paid by personal check to John Hancock during your temporary leave period. You will be transferred to direct billing, as described above.

Your LTC Plan payroll deduction contributions will resume when you return to paid status. 

You should contact Human Resources for more information concerning the continuation of your benefit coverage during an authorized FMLA leave. 

*Family and Medical Leave Act 

Military Leave: Reservists who are called to active duty with the Armed Forces of the United States have special benefit continuation and reemployment rights under the law (see Administrative Information). In addition, the federal Family and Medical Leave Act (FMLA) was amended to add two new leave rights related to military service, effective January 16, 2009: 

  • Active Duty Leave: Eligible employees are entitled to up to 12 weeks of leave because of “any qualifying exigency” due to the fact that the spouse, son, daughter, or parent of the employee is on active duty, or has been notified of an impending call to active duty status, in support of a contingency operation.
  • Injured Service Member Leave: An eligible employee who is the spouse, son, daughter, parent, or next of kin of a covered service member who is recovering from a serious illness or injury sustained in the line of duty on active duty is entitled to up to 26 weeks of leave in a single 12-month period to care for the service member. The employee is entitled to a combined total of 26 weeks for all types of FMLA leave in the single 12-month period.

WHO INSURES YOUR BENEFITS?

Your Long-Term Care Insurance Plan benefits are insured by the John Hancock Life Insurance Company.