Long-Term Care Plan

Covered Long-Term Care Expenses 

This section provides an overview of your Long-Term Care (LTC) Plan’s covered expenses, but it does not include all of the details about the plan and its operation. 

There are additional LTC Plan resources available to you. You should consult these resources for more information about the plan and its operation, including covered plan services, approved long-term care providers, and the plan’s terms and conditions for receiving benefits: 

  • The LTC Plan Insurance Certificate, which you can obtain from Human Resources.
  • The John Hancock Customer Service Center, which is available to answer your questions about the plan at 1-800-711-9407 (Monday through Friday from 8:30 a.m. to 6:30 p.m., Eastern Time). 

COVERED LONG-TERM CARE FACILITIES
In order to qualify for LTC Plan benefits, long-term care must be furnished by a qualified facility that meets the Insurance Company’s standards for quality care. 

The LTC Plan covers long-term care that is provided in the following settings: 

  • nursing homes
  • alternate care facilities
  • community based professional care
  • in the covered person’s home
  • hospice facilities 
You can contact the John Hancock Customer Service Center at 1-800-711-9407 (Monday through Friday from 8:30 a.m. to 6:30 p.m., Eastern Time) if you have a question about qualified long-term care facilities.

NURSING HOME CARE
The LTC plan covers skilled, intermediate, and custodial care provided to inpatients in a qualified nursing home. A qualified nursing home is a separate (or distinctly separate) facility that: 

  • is licensed to provide nursing care in the jurisdiction in which it operates; or
  • is approved by Medicare as a skilled nursing facility. 

Covered Nursing Home Services
The LTC Plan’s payment for covered nursing home services is subject to the Daily Benefit and Certificate Limit maximums described under "How LTC Plan Benefits Are Determined" in the How Your Long-Term Care (LTC) Plan Works section. 

The LTC Plan covers the following nursing home services, up to the Daily Benefit limit: 

  • room and board
  • nursing care
  • custodial care
  • therapy service 

For example, assume that you elected the $250 Daily Benefit option when you enrolled in the plan. In this case, the plan will reimburse you for up to $250 towards the cost of covered services for each day of confinement in a qualified nursing home (up to your Certificate Limit). 

You should consult the LTC Plan Insurance Certificate for more complete information about nursing home coverage (you can obtain this certificate by contacting Human Resources). You can also contact John Hancock’s Customer Service Center at 1-800-711-9407 (Monday through Friday from 8:30 a.m. to 6:30 p.m., Eastern Time) if you have a question about covered nursing home services.

ALTERNATE CARE FACILITY
The LTC Plan covers care in a qualified alternate care facility. A qualified alternate care facility is a separate (or distinctly separate) facility that primarily provides 24-hour custodial care, and: 

  • is not a hospital, hospice facility, or nursing home; and
  • is licensed by an appropriate licensing agency to primarily provide custodial care; or
  • if licensing is not required, it is engaged primarily in providing custodial care to at least 5 unrelated inpatients; and
    • provides 3 full meals daily;
    • has an employee who is trained to provide custodial care on duty at all times;
    • provides care as a part of a Plan of Care;
    • has appropriate procedures for medication management; and
    • has formal arrangements for obtaining aid in the event of a medical emergency. 

For example, assume that you elected the $150 Daily Benefit option when you enrolled in the plan. In this case, the plan will reimburse you for up to $150 towards the cost of covered services for each day of confinement in a qualified alternate care facility (up to your Certificate Limit). 

You should consult the LTC Plan Insurance Certificate for more complete information about Alternate Care Facility coverage (you can obtain this certificate by contacting Human Resources). You can also contact John Hancock’s Customer Service Center at 1-800-711-9407 (Monday through Friday from 8:30 a.m. to 6:30 p.m., Eastern Time) if you have a question about covered Alternate Care Facility services.

COMMUNITY BASED PROFESSIONAL CARE
The LTC Plan covers Community Based Professional Care. Community Based Professional Care includes services provided by a qualified: 

  • home health care provider;
  • homemaker service; or
  • hospice care provider. 

Community Based Professional Care may be provided in the covered person’s home, or in a qualified adult day care center. 

To qualify for LTC Plan benefits, Community Based Professional Care must be: 

  • specified in an approved care plan; and
  • provided by someone other than a member of your immediate family.       

For example, assume that you elected the $100 Daily Benefit option when you enrolled in the plan. In this case, the plan will reimburse you for up to $100 towards the cost of covered services for each day of Community Based Professional Care (up to your Certificate Limit). 

You should consult the LTC Plan Insurance Certificate for more complete information about Community Based Professional Care coverage (you can obtain this certificate by contacting Human Resources). You can also contact John Hancock’s Customer Service Center at 1-800-711-9407 (Monday through Friday from 8:30 a.m. to 6:30 p.m., Eastern Time) if you have a question about covered Community Based Professional Care services.

HOME CARE
The LTC Plan covers long-term care services that that are provided in a covered person’s home. This coverage includes:

  • the Stay at Home benefit; and
  • the Informal Care benefit.

Stay at Home Benefit

The Stay at Home benefit includes the following services that are furnished by qualified providers: 

  • care planning visit
  • home modification
  • emergency medical response system
  • durable medical equipment
  • home safety check
  • provider care check
  • caregiver training 

The maximum plan payment for qualified Stay at Home services is 30 times your Daily Benefit amount (see chart below). This payment will not reduce your Certificate Limit. 

Informal Care Benefit
The LTC Plan covers custodial care and homemaker services that are furnished in the covered person’s home. Covered homemaker services are non-medical support services that include: 

  • supervision of self-administration of medication
  • meal preparation
  • light housekeeping 

Informal Care services can be provided by a member of the covered person’s family. This family caregiver may reside outside of the covered person’s home. 

Informal Care payments are determined on a daily basis, and are subject to a calendar year maximum (see below). These payments will not reduce your Certificate Limit. 

Benefit Amounts
As the following chart shows, the amounts of your Stay at Home and Informal Care benefits are determined by the Daily Benefit option that you elected: 

Daily Benefit
 Option Informal Care
 Daily Benefit* Stay at Home â€¨Lifetime Benefit
$100 $25.00 $3,000
$150 $37.50 $4,500
$200 $50.00 $6,000
$250 $62.50 $7,500
$300 $75.00 $9,000

*Subject to a calendar year maximum of 30 times the Informal Care daily benefit shown

For example, assume that you elected the $250 Daily Benefit option. If you receive covered care in your home, the plan will pay: 

  • up to $62.50 for each day of covered Informal Care (subject to a calendar year maximum of $1,875*); and
  • up to a lifetime maximum of $7,500** for covered Stay at Home care.       

*$62.50 x 30 = $1,875

**$250 x 30 = $7,500 

You should consult the LTC Plan Insurance Certificate for more complete information about Home Care coverage (you can obtain this certificate by contacting Human Resources). You can also contact John Hancock’s Customer Service Center at 1-800-711-9407 (Monday through Friday from 8:30 a.m. to 6:30 p.m., Eastern Time) if you have a question about covered Home Care services.

HOSPICE CARE
Hospice Care is care that is provided for terminally ill persons who are diagnosed by a physician as having a life expectancy of 6 months or less. The LTC Plan covers Hospice Care that is provided: 

  • in a free-standing hospice facility
  • in a nursing home
  • at home 

To qualify for LTC Plan benefits, hospice care must be furnished by an approved hospice or home health care agency that is an extension of a hospice. 

Covered Hospice Care benefits include: 

  • services provided for the relief of pain and management of terminal illness; and
  • counseling for the terminally ill patient. 

For example, assume that you elected the $300 Daily Benefit option when you enrolled in the plan. In this case, the plan will pay up to $300 towards the cost of covered services for each day of Hospice Care (up to your Certificate Limit). 

You should consult the LTC Plan Insurance Certificate for more complete information about Hospice Care coverage (you can obtain this certificate by contacting Human Resources). You can also contact John Hancock’s Customer Service Center at 1-800-711-9407 (Monday through Friday from 8:30 a.m. to 6:30 p.m., Eastern Time) if you have a question about covered Hospice Care services.

ADDITIONAL LTC PLAN SERVICES AND BENEFITS
LTC Plan coverage provides you with a number of additional covered services and benefits: 

  • Respite Care Benefit
  • Temporary Bed-Holding Benefit
  • Waiver of Premium
  • International Coverage
  • Return of Premium at Death Benefit
  • Portability 

Respite Care Benefit
This benefit pays for covered services (provided on a short-term basis) that are designed to give an unpaid caregiver temporary relief from his or her caregiving duties. 

Temporary Bed-Holding Benefit
This benefit applies if you are receiving plan benefits and your stay in a nursing home, alternate care facility, or an inpatient hospice facility is interrupted for any reason. In this case, the plan will pay to hold your bed for up to 30 days per calendar year. 

Waiver of Premium
This benefit provides for a waiver of your premium contributions while you are receiving plan benefit payments. The Waiver of Premium Benefit will begin as of the first day of the month that is on or next following the date that you satisfy the plan’s 90-day Elimination Period, provided that you meet the following conditions on that date: 

  • you need substantial assistance from another individual to perform at least two of the Activities of Daily Living;* or
  • you need substantial supervision due to the presence of a severe cognitive impairment. 

The Waiver of Premium Benefit will end as of the date that you are no longer eligible for plan benefit payments.

*Explained under "Covered Health Conditions" in the How Your Long-Term Care (LTC) Plan Works section 

International Coverage
Under limited conditions, the plan will pay for certain covered services that are received outside of the United States. 

Return of Premium at Death Benefit
This benefit may provide for a return of all or a portion of premiums paid on behalf of a covered person who dies before age 70. It is paid to the covered person’s estate. 

The amount of the Return of Premium at Death Benefit (if any) is determined by subtracting any benefits paid (or payable) by the plan from the total amount of premiums paid by the covered person. 

Portability
If your employment with the Company ends, you may be eligible to convert your coverage to an individual policy issued by the Insurance Company. 

You should consult the LTC Plan Insurance Certificate for more complete information about the additional plan services and benefits described above (you can obtain this certificate by contacting Human Resources). You can also contact John Hancock’s Customer Service Center at 1-800-711-9407 (Monday through Friday from 8:30 a.m. to 6:30 p.m., Eastern Time) if you have a question about these additional services and benefits.