Key Terms

Key Terms  

Overview

Deductible – The amount you pay toward covered services each year before the plan begins paying benefits.

 

Copayment/copay – A flat fee that you pay for health care services at the time they’re received regardless of the actual amount charged by your doctor or provider. This generally applies to physician office visits and prescription drugs.

 

Coinsurance – The portion of covered expenses that you must pay for care, after first meeting a deductible. This is typically a percentage of negotiated costs.

 

Out-of-pocket maximum – The most you have to pay each year for health care services. Your deductible and prescription drug coverage count toward your out-of-pocket maximum in all three medical plans.

 

COBRA – A federal law that allows workers and dependents who lose their medical, dental, vision and/or FSA coverage to continue group coverage for a specific length of time by paying the full cost of those selected coverages.

  • Who is the provider?

    Your employer has made arrangements with Mercer Voluntary Benefits to offer you access to a Long-Term Care Insurance Service. This service will help you review your needs and offer you options from Transamerica.
  • How can this help me?

    Long-Term Care Insurance helps you offset the costs of care for help with activities of daily living, such as bathing, dressing, eating, toileting, transferring and continence. This coverage will also provide benefits if you suffer from a severe cognitive impairment, which may be the result of diseases (like Alzheimer’s disease) or aging. Long-term care services may be at your home, in a nursing home, an assisted living facility, or a hospice facility.

    You may need long-term care services in three years or three days; it's impossible to predict how long you'll be in good health or if you'll suffer from long-term effects of an accident or debilitating disease. And, because long-term care insurance rates are based on your age at the time of purchase, the younger you are when you enroll, the less your premiums will be.
  • When can I enroll?

    As a new hire, you can enroll during your company’s designated enrollment period. Once you’ve reached the designated enrollment period you will have a certain number of days to apply with simplified underwriting. After the designated enrollment period, you may enroll with full underwriting.
  • How much will this coverage cost?

    Your cost is based on several factors including your age, any special features you select, and the amount of coverage you want. 
  • What if my employment status changes?

    When you leave or retire from your current employer, you can continue your coverage without interruption. Although payroll deduction will no longer be available if you retire or leave your company, you can opt for other payment methods such as direct checking or bank account deduction, credit card billing or home billing.
  • What is the cost of waiting to purchase Long Term Care Insurance?

    If you are thinking of waiting to purchase LTC insurance coverage, consider the impact of waiting:

    • Increases the risk of being ineligible for insurance.
    • Can increase the overall cost of coverage because premium rates increase depending on your age when you apply. Premium rates are based on your age at time of enrollment and the plan design you select, they do not increase with your age.
    • Decreases the overall time you have LTC insurance coverage, leaving you responsible for the cost of care if you need long-term care services.
    • Family may sacrifice income by reducing their hours at work to care for you.
    • Without LTC insurance, individuals and families risk exposure to emotional and financial hardships.


    Waiting delays the covering of your LTC risk and can cost you money and deplete savings.

  • Won’t the Federal Government pay for my Long Term Care?

    Medicare provides minimal financial support for LTC services. Medicare was designed to pay for acute medical conditions and post-rehabilitative care; it was not intended to pay for costs associated with LTC. To qualify for nursing home care under Medicare, a three-day hospital stay is required, and care must be rehabilitative in nature. If these conditions are met, Medicare will pay for the first 20 days. Days 21-100 require a co-payment. There is no coverage after day 100.