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Q: Who is the State of South Dakota’s Long Term Care Carrier?
A: The State of South Dakota’s Long Term Care carrier is Unum Insurance in Portland, Maine.
Q: What is Long Term Care?
A: Long Term Care is the type of care received at home or in a facility when someone needs assistance with at least two (2) of six (6) Activities of Daily Living (ADL).
Q: What are the six ADLs?
A: Bathing, Dressing, Toileting, Transferring, Eating, and Continence.
Q: What if I have already lost one or more ADL?
A: The contract stipulates that an insured individual must lose at least two ADLs after the inception date of an employee’s coverage. Any loss of ADL prior to the inception date is not eligible for consideration.
Q: Who’s eligible for Long Term Care?
A: Active benefit eligible State employees enrolled in the State Supplemental Life Insurance; Family members of active employees; Includes spouses, adult children, siblings, parents (in-law), and grandparents (in-law) ages 18 to 80 Retirees; spouses of Retirees
*An employee or retiree must be on the contract for family members to be eligible.
Q: Is there a waiting period before I can receive benefits?
A: Yes. This plan has an elimination period of 90 consecutive days which you must wait before benefits become payable. This time period must be satisfied only once during the life of your plan.
Q: How do I apply for the State Group Supplemental Life Insurance coverage?
A: New Hires may enroll in the State Group Supplemental Life Insurance Coverage within the first 30 days from their date of hire by: Applying online or Completing the Group Life Benefit Form located at the South Dakota Bureau of Human Resources website.
Existing employees may enroll in the State Group Supplemental Life Insurance Coverage anytime during the Plan Year by: Applying online, or Completing the Group Life Benefit Form and the Evidence of Insurability Form located at the South Dakota Department of Human Resources website.
Q: When can I apply for Long Term Care?
A: Employees can apply for LTC anytime during the plan year if approved for supplemental life. Retirees can apply anytime during the plan year. Family members can apply at any time if the employee or retiree is already on the plan.
Q: Does the State of South Dakota pay for a portion of my benefit?
A: Yes. There is a State funded contract for State employees who qualify for LTC.
Q: What is the free State funded benefit given to me by the State of South Dakota?
A: As a qualified employee, the State of South Dakota will give you a base benefit of $1,500 per month coverage with a two-year duration. If you go to a nursing facility, benefits are paid at 100%; assisted living benefits are paid at 60%; and home care benefits are paid at 50%.
Q: Where can care be received?
A: A Long Term Nursing facility--The contract will pay 100% of the nursing home benefit amount you selected for care in a Long Term Care facility.
An Assisted Living facility--The contract will pay 60% of the nursing home benefit amount you selected for care in an Assisted Living facility.
An individual’s home--The contract will pay 50% of the nursing home benefit amount you selected for care at home by a home care professional.
Q: Can a family member or friend care for me?
A: Yes. With an added cost, you have the ability to add the “Total Home Care” benefit. Total Home Care means the contract will pay 50% of the benefit amount when a family member or friend provides is used to provide care at home.
Q: Can I purchase additional coverage?
A: Yes. The contract allows employees to increase their coverage in $1,000 per month increments ranging from $2,000 to $8,000 per month at additional cost.
Q: Can I increase the benefit duration beyond the two-year State funded duration?
A: Yes. The duration can also be extended to either six years or Unlimited at additional cost.
Q: Can I purchase a LTC plan with compound inflation?
A: Yes. You may choose a plan with 5% compound inflation at an additional cost. This option will increase the benefit amount you have selected by 5%, compounded on an annual basis.
Q: What is the South Dakota Partnership Long Term Care program?
A: The Partnership program is administered by the SD Department of Social Services and the Division of Insurance. This plan allows an insured employee, retiree and/or family member to maintain their personal assets at a value equal to the amount of Long Term Care benefit paid out for their care. For example, an employee has $5,000 a month benefit with a 6-year duration ($5,000 x 12 months x 6 years = $360,000). After that amount is paid out, that member may retain an amount equal to the lifetime benefit of $360,000 in personal assets and still qualify for Medicaid. This is called the “asset protection.”
Q: Do all of the State of South Dakota Plans meet the Partnership qualification?
A: No. There are limits for a plan to be Partnership Qualified. To qualify, the benefit must be at least $2,000 per month, carry a two-year duration, and provide 5% compound inflation. Applicants over the age of 76 do not require the inflation option. Note: This criterion is based on the design of the State of South Dakota sponsored plan.
Q: Is this an individual contract?
A: No. The State of South Dakota contract is a group contract. This means there is one master contract held by the State of South Dakota. Because this is written on a group basis, the underwriting is much more liberal than most individual contracts, and pricing is usually much better.
Q: If I retire or leave State employment, can I take the Long Term Care coverage with me?
A: Yes. The plan is fully portable. Once you leave State employment, the portion being paid by the State of South Dakota, and any portion payroll deducted will be transferred over to a private pay arrangement between you and Unum Insurance. Rates will remain the same, provided you do not change or alter coverage after you leave employment with the State.
Q: Will the rates ever change?
A: It is possible for rates to change, but they will never change based on your age or because you leave employment with the State. For current rates click here.
Q: Can I be declined coverage?
A: New employees who meet the eligibility requirements and apply within 30 days of hire will be granted guaranteed issue (with the exception of the Unlimited duration option). Guaranteed issue means there are no health questions, and you cannot be declined due to health issues. Existing employees, retirees and family members must complete the Evidence of Insurability and may be declined coverage based on current or pre-existing health conditions.
Q: Does Medicare provide Long Term Care Benefits?
A: Yes, but there are limits. Medicare will only pay Long Term Care expenses following a 3-day hospital stay. The Long Term Care assistance must be for the same condition for which you were hospitalized. If you qualify, the first 20 days are paid at 100%. Any following days are covered at a reduced payment to a maximum of 100 days.
Q: What is the average nursing home cost in South Dakota?
A: In 2012, the average private pay rate for a semi-private room in a South Dakota nursing home was $182/day, or over $66,000/year. The average stay in South Dakota is 2.5 years, but nationally it is closer to 4 years.
Q: Is Long Term Care Coverage just for old people?
A: No. Of those receiving Long Term Care or requiring some living assistance, 25% are under the age of 65.
Q: Is most Long Term Care delivered in a nursing home?
A: No. Only 18% of those currently receiving Long Term Care are in a nursing facility. Two percent are in an assisted living facility and 80% are receiving home care.
Additional questions or concerns:
You may contact Unum’s local representative, Risty Benefits, Inc at 866-237-9411 or email firstname.lastname@example.org.
As Plan Administrator, Unum has final authority to make determinations on eligibility, enrollment and issues not specifically addressed in the Long Term Care information provided on this website. The contract between Unum and the South Dakota State