The plan, now jointly sponsored by the NFL Management Council and the NFL Players Association, was begun in 2011 when it was recognized that providing long term care coverage to eligible retired players could deliver important financial assistance when players experienced the inevitable effects of aging.
This message, intended for retired NFL players who want to know more about the program, addresses the definition of long term care and the need for long term care protection, and provides answers to Frequently Asked Questions (FAQ) regarding the components of the program including eligibility, enrollment, underwriting, benefits and funding.
What is Long Term Care?
Long Term Care is the assistance provided to a person who either 1) has a severe cognitive impairment requiring continual supervision, or 2) is unable to perform two of the six activities of daily living (bathing, dressing, eating, getting up from a bed or chair, toileting and continence) without hands on assistance. In other words, it is custodial care when people can no longer completely care for themselves. Long term care services may also include help with day to day activities such as medication management, personal hygiene, light housekeeping or meal preparation. Long term care can be provided in the home (most common), an adult day care facility, assisted living facility or a nursing home.
Three important reasons to own Long Term Care Insurance (LTCI)
1 – The chance of needing care is high – the U.S. Department of Health and Human Services estimates that nearly 70 percent of people over age 65 will need long term care services at some point in their lives. And it doesn’t just affect older people, 40 percent of those receiving long term care are working age adults under age 64.
2 – Long term care services are expensive – the national average cost of a semi-private room in a nursing home is more than $76,000 per year. A private room is even more – approaching $88,000 per year. A year in an assisted living facility is nearly $38,000. Home health care can cost as much as $41,000 per year for a home health aide and $36,000 for homemaker services (based on services received eight hours per day, 20 days per month).
3 – Funding options may be limited – when it comes to paying for long term care services, people have the option to self-fund their long term care expenses by paying out-of-pocket but, considering the current costs, how long would their assets last? Next, they may assume the government will take care of them but Medicare pays only a limited amount while Medicaid is a program for people with very limited assets. Or, they can purchase long term care insurance.
Owning long term care insurance just makes good sense. With LTCI:
People get the care they need – People who own long term care insurance are more likely to seek hired services because they know they’ll have help paying the bills.
They don’t have to go to a nursing home – Most people who need long term care services don’t need the “skilled care” nursing homes provide, they would prefer to receive care at home in familiar surroundings. A long term care policy provides benefits for “custodial care”, which is help with activities of daily living. Medicaid doesn’t cover this type of care, but long term care insurance does.
Family relationships are preserved – Most caregivers are family members. Being a full-time caregiver can put a lot of stress on family relationships particularly on adult children who have their own family and career obligations, or may not live nearby. Caregiving also puts family members own health in jeopardy as the stress, lack of sleep, and emotional strain can be detrimental. Long term care coverage provides the funds to hire services that supplement care provided by family members.
Retirement assets are protected – Long term care coverage provides the funds to help people pay for the care they need, whether in their own homes, an assisted living facility or a nursing home. Individuals have the freedom to enjoy retirement years as planned when their financial assets are protected from the high cost of long term care.
Frequently Asked Questions:
Am I eligible to enroll in the program?
NFL Retirees eligible for the Program are those who 1) are vested in the Bert Bell/Pete Rozelle NFL Player Retirement Plan and 2) have attained age 50 but have not yet attained age 76. The spouses of eligible retirees are also eligible to enroll.
When can I enroll in the program?
Coverage is offered during an open enrollment period each year to 1) newly eligible retirees that turned 50 since the last enrollment period and 2) retirees who were previously eligible for any enrollment period but did not make application.
The next open enrollment will be held April 1, 2017 to June 30, 2017. The date of birth range for newly eligible retirees will be November 1, 1964 through March 31, 1966.
How do I make application?
When you become eligible, a letter and package of information describing the benefits and the enrollment process will be sent to you from Transamerica. You start the process by calling the number given on the letter and you complete the application over the phone.
How do I get approved for coverage?
You must satisfy the insurance company’s underwriting requirements before coverage will be offered to you. There are two levels of underwriting:
Simplified Underwriting is available only to newly eligible retirees who are actively working an average schedule of at least 20 hours per week. This underwriting level consists of satisfactory completion of an abbreviated list of health questions in the policy application, a telephone interview cognitive test, a Medical Information Bureau (MIB) report and a prescription drug database report. However Full Underwriting may be required if the MIB or prescription drug database report are inconsistent with information provided in the application.
Full Underwriting will apply to you if you do not meet the conditions for Simplified Underwriting and to your eligible spouse. Full underwriting requires completion of all health questions in the policy application, the additional requirements of Simplified Underwriting, full personal medical records and, if the applicant is age 66 or older, an in-person cognitive assessment.
What are the benefits of the plan?
- Maximum daily benefit: $150/day
- Maximum benefit: $219,000
- Benefit period: 4 years*
- Elimination (waiting) period for facility care: 90 days
- Elimination period for home health care/adult day care: 0 days
- Monthly Home Health Care – $4,500 benefit per month, not limited by $150/day
*Assumes that $150 would be spent every day for 1460 days (4 x 365). If rate of spending is reduced, the maximum benefit of $219,000 will last longer than 4 years.
Voluntary Additional Benefits:
If you are approved for coverage you may purchase the 5% compound Benefit Increase Option (inflation protection) and the Nonforfeiture Benefit. In addition, you may purchase coverage on your spouse at a discount of up to 40% depending on the level approved by the state of residence.
Who pays for the coverage? The NFLMC pays the premium on Basic Benefits for the retiree. Voluntary Additional Benefits are paid by you or your spouse through direct billing from Transamerica.