FAQs

Why is it so important for me to apply during this initial enrollment?

Guarantee Issue (GI) ages 19 through 70 – (No Medical Questions for employees up to $150K in Life Insurance including $300K in Long Term Care Insurance) during this initial enrollment. Modified GI for spouses – (one qualifying question) during this initial enrollment.

What does this policy provide for coverage?

This coverage combines the benefits of both Life Insurance protection for your family along with Long Term Care benefits, which can be utilized to help pay for services such as home healthcare, adult day care, assisted living facilities and nursing home expenses. Long Term Care is personal care - help with everyday activities such as bathing and dressing (also known as "Activities of Daily Living”) and/or care for severe cognitive impairments like Alzheimer’s Disease or Dementia.

What is the difference between Long Term Care and Long-Term Disability insurance?

Long Term Care insurance helps cover the cost of a nursing home, assisted living, adult day care or home health care if you become unable to care for yourself. Long Term Disability insurance replaces a portion of the income you will lose if you are unable to work because of an injury or illness. It pays for your lost income. Unlike disability insurance, Long Term Care insurance does not end when one retires – it remains active into retirement, provided premiums are paid.

Can I add my spouse to this employer's offering?

Yes, spouses are eligible even if the employee does not apply for coverage.

A spouse, ages 19 through 60, can elect 50% of the employee coverage up to $25,000 in Life Insurance including $50,000 in Long Term Care with one qualifying medical question, called Modified Guaranteed Issue.

A spouse, ages 19 through 70, can elect 100% of the employee amount up to $75,000 in Life Insurance including $150,000 in Long Term Care with three medical questions, called Conditional Guaranteed Issue.

A spouse, ages 19 through 70, can elect 100% of the employee amount up to $112,500 in Life Insurance including $225,000 in Long Term Care with additional medical questions called Simplified Issue.

If your spouse also works for this employer, one should apply for coverage as an “employee” (not as a spouse) to qualify for Guaranteed Issue underwriting (no health questions).

How much life insurance can I purchase and how is my monthly Long Term Care benefit calculated?

The employee life insurance options range from $10,000 up to $225,000. Up to $150,000 in life insurance may be elected during this initial enrollment with no medical questions through age 70.

The monthly Long Term Care benefit is 4% of the death benefit and can be used for homecare and/or facility care for up to 50 months. For example, a $50,000 policy provides a $2,000 monthly Long Term Care benefit up to $100,000 in total Long Term Care benefits.

Is the death benefit guaranteed to remain the same?

Your death benefit is guaranteed through age 120. The death benefit is 100% guaranteed for the longer of 25 years or age 99. Any reduction, never greater than 50% in death benefit (after age 99 or 25 years, the longer of) will result in a corresponding decrease in the monthly Long Term Care benefit.

Can I take my coverage with me if I were to leave work or retire and, if so, do the rates change?

This is permanent life insurance designed to last a lifetime. Should you leave your employer or retire, you can keep your coverage at the same cost and benefit levels.

When I start receiving LTC benefits, does the death benefit decrease as each monthly LTC benefit is paid out?

Yes, the death benefit is accelerated (reduced) to pay each monthly LTC benefit. For example, a $50,000 policy provides a $2,000 monthly LTC benefit, so after the first monthly LTC benefit is paid, the net death benefit would be $48,000. This depletion of the death benefit continues as LTC benefits are paid however once the death benefit is reduced to 50%, not to exceed $50,000, the death benefit does not decrease. See question below.

Does the policy provide a way to “replenish” or restore my death benefit as LTC benefits are paid?

Yes, all coverage includes 50% Restoration of Death Benefits. Once the death benefit falls below 50% of its original value, it is restored to 50% of its original value up to a maximum of $50,000.

For Example: $100,000 in coverage would pay $4,000 per month in LTC benefits ($100,000 x 4%). If the insured received $24,000 or 6 months of LTC benefits ($4,000 per month x 6 months = $24,000), the net death benefit would be $76,000. If the insured then died, $76,000 in life insurance proceeds would be paid to the beneficiary. Alternatively, if the insured had received $52,000 or 13 months of LTC benefits ($4,000 per month x 13 months = $52,000), the death benefit would be restored to 50% of its value or $50,000. If the insured were to die, the policy would pay $50,000 in life insurance benefits.

How is my rate determined?

This insurance offers unisex rates based on your age (as of the effective date), tobacco/nicotine usage, and coverage level selected.

How will I pay my monthly premiums?

Your premiums will be automatically deducted from your personal checking or savings account each month. There is no payroll deduction. Credit cards are not allowed for payments.

Are the premiums pre-tax or post-tax?

The premiums are paid post tax.

Do premiums continue when on LTC claim?

The plan has Waiver of Premium, which means that while you are receiving LTC benefits, all premiums are waived.

Am I able to review my plan and return it to the insurance company if I am not 100% satisfied?

The Certificate holder may, within 30 days after the Certificate is delivered, return the Certificate to the Carrier’s Administrative Office, and receive a full refund of any premiums that have been paid. Once returned, the Certificate will be void from the effective date.

Can my rates increase?

Life insurance premiums are guaranteed and cannot increase. LTC rates are subject to change.

What are the health questions employees need to answer for underwriting?

Employee Guaranteed Issue (No Health Questions)
Guaranteed Issue is available for employees ages 19 through 70. Employee Guaranteed Issue Limits are $10,000 up to $150,000 for life insurance. There is just one “Actively at Work” question (below).

“Is the employee actively at work performing the regular duties of the job in the usual manner and at the usual place of employment?”

Employees who answer “No” to the above Actively at Work question are ineligible to enroll but may apply for coverage upon their return to work and during the next enrollment period.

Employee Conditional Guaranteed Issue
Conditional Guaranteed Issue is available for employees ages 19 through age 70 applying for amounts above $150,000 up to $200,000. If an employee through age 70 is not approved for amounts above $150,000 (if applying during the initial enrollment), the employee will receive the $150,000 on a guaranteed issue basis.

Employee Conditional Guaranteed Issue Health Questions

• Has the Employee missed more than 5 consecutive days of active work due to an illness or injury in the past 3 months?
• Has any proposed Insured been treated in a medical facility, hospitalized, or disabled in the past 6 months, excluding flu or cold? Hospitalized means in-patient or outpatient, whether or not confined. Treated in a medical facility does NOT include a regular physician’s office visit.
• Has any Proposed Insured, within the last 10 years, been tested positive for exposure to the Human Immunodeficiency Virus (HIV) infection, been diagnosed by a physician as having Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) caused by the HIV or other sickness, or condition derived from such infection?
  Note: Applicants who answer “Yes” to the above HIV/AIDS question are ineligible for coverage.
• Has any person/Spouse proposed for coverage been seen or treated by a licensed physician or other medical practitioner within the past 6 months, excluding flu, cold or routine physical?

NOTE: Employees who answer “Yes” to any Conditional Guaranteed Issue questions (excluding the HIV/AIDS question) are required to answer the Simplified Issue health questions (below).

Employee Simplified Issue
Simplified Issue is available for employees ages 19 through age 70 applying for amounts above $200,000 up to $225,000. If an employee through age 70 is not approved for amounts above $200,000 (if applying during the initial enrollment), the employee will receive the $150,000 on a guaranteed issue basis.
Employee Simplified Issue is available for employees ages 71 through 80. The Simplified Issue Limit is $50,000 for employees ages 71 through 80.

Employee Simplified Issue Health Questions

• Has the Employee missed more than 5 consecutive days of active work due to an illness or injury in the past 3 months?
• Has any proposed Insured been treated in a medical facility, hospitalized, or disabled in the past 6 months, excluding flu or cold? Hospitalized means in-patient or outpatient, whether or not confined. Treated in a medical facility does NOT include a regular physician’s office visit.
• Has any Proposed Insured, within the last 10 years, been tested positive for exposure to the Human Immunodeficiency Virus (HIV) infection, been diagnosed by a physician as having Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) caused by the HIV or other sickness, or condition derived from such infection?
  Note: Employees who answer “Yes” to the above HIV/AIDS question are ineligible for coverage.
• Has any person/Spouse proposed for coverage been seen or treated by a licensed physician or other medical practitioner within the past 6 months, excluding flu, cold or routine physical?
• Height: Weight:
• Within the past 5 years, has any proposed Insured been admitted or advised to be admitted to a hospital or received medical advice or treatment by a licensed member of the medical profession for: Inquiries are specific as to treatment or diagnosis as provided by a licensed health care practitioner.
• Any chest pain, heart disease, stroke or paralysis, lung or respiratory disease, blood disease or high blood pressure? If yes, provide most recent blood pressure reading and date.
• Any cancer, tumor, disorder of the kidney, liver disease or hepatitis?
• Any mental or psychiatric disorder, stomach or intestinal disorder or reproductive organ disorder?
• Received or been advised to have, by a licensed member of the medical profession, counseling, or treatment for the use of alcohol, drugs, illegal drugs, or used any illegal drug or controlled substance?
• Taken any prescription medication in the past 6 months (If “Yes”, state name of medication, reason for taking frequency and dosage)?
• Had or been advised to have, by a licensed member of the medical profession, an electrocardiogram, x-ray, blood study, urinalysis, or any other diagnostic study, operation, or treatment?
• Other than stated above, within the past 5 years, had any other illness, operation, or treatment?

What are the health questions Spouses need to answer for underwriting?

Modified Guaranteed Issue (1 Qualifying Question)
Modified Guaranteed Issue is available for spouses ages 19 through 60. Spouse Modified Guaranteed Issue Limits are the lesser of 50% of the employee amount or $25,000. For example, if the employee applies for $10,000, the maximum Modified Guaranteed Issue amount the spouse could apply for would be $5,000. If the employee applies for $100,000, the maximum Modified Guaranteed Issue amount the spouse could apply for would be $25,000.

Modified Guaranteed Issue Health Question
If applying for coverage, is your spouse currently hospitalized, receiving home health care or receiving / applying to receive disability benefits?

Spouse Conditional Guaranteed Issue
Conditional Guaranteed Issue (some health questions) is available for spouses ages 19 through 70. Spouse Conditional Guaranteed Issue Limits are for coverage amounts that exceed Modified GI up to $75,000.

Spouse Conditional Guaranteed Issue Health Questions

• Has any proposed Insured been treated in a medical facility, hospitalized or disabled in the past 6 months, excluding flu or cold? Hospitalized means in-patient or outpatient, whether or not confined. Treated in a medical facility does NOT include a regular physician’s office visit.
• Has any Proposed Insured, within the last 10 years, been tested positive for exposure to the Human Immunodeficiency Virus (HIV) infection, been diagnosed by a physician as having Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) caused by the HIV or other sickness, or condition derived from such infection?
  Note: Applicants who answer “Yes” to the above HIV/AIDS question are ineligible for coverage.
• Has any person/Spouse proposed for coverage been seen or treated by a licensed physician or other medical practitioner within the past 6 months, excluding flu, cold or routine physical?

NOTE: Spouses who answer “Yes” to any Conditional Guaranteed Issue questions (excluding the HIV/AIDS question) are required to answer the Simplified Issue health questions (below).

Spouse Simplified Issue
Simplified Issue is available for spouses ages 19 through 70. Spouses Simplified Issue Limits are for coverage amounts that exceed Conditional GI limits up to $112,500 in life insurance.

Spouse Simplified Issue Health Questions:

• Height: Weight:
• Within the past 5 years, has any proposed Insured been admitted or advised to be admitted to a hospital or received medical advice or treatment by a licensed member of the medical profession for: Inquiries are specific as to treatment or diagnosis as provided by a licensed health care practitioner.
• Any chest pain, heart disease, stroke or paralysis, lung or respiratory disease, blood disease or high blood pressure? If yes, provide most recent blood pressure reading and date?
• Any cancer, tumor, disorder of the kidney, liver disease or hepatitis?
• Any mental or psychiatric disorder, stomach or intestinal disorder or reproductive organ disorder?
• Received or been advised to have, by a licensed member of the medical profession, counseling or treatment for the use of alcohol, drugs, illegal drugs, or used any illegal drug or controlled substance?
• Taken any prescription medication in the past 6 months (If “Yes”, state name of medication, reason for taking frequency and dosage)?
• Had or been advised to have, by a licensed member of the medical profession, an electrocardiogram, x-ray, blood study, urinalysis, or any other diagnostic study, operation, or treatment?
• Other than stated above, within the past 5 years, had any other illness, operation, or treatment?

If I answer “Yes” to any of the health questions, will I be declined coverage?

Employees who are eligible for the Guaranteed Issue offer will not be declined for coverage amounts up to $150,000, even if declined by underwriting for higher amounts of coverage.

Employees who answer “No” to the “Actively at Work” Guaranteed Issue question will be ineligible for coverage but may enroll for coverage upon return to work and during the next enrollment period. Applicants who answer “Yes” to the HIV/AIDS will be ineligible for coverage, unless they qualify for the Guaranteed Issue coverage amount.

Spouses who answer “Yes” to any CGI/SI questions will be ineligible for higher levels of coverage, however, they can still receive coverage up to 50% of the employee amount (max $50,000) if they answer “No” to this MGI question: If applying for coverage, is your spouse currently hospitalized, receiving home health care or receiving / applying to receive disability benefits?

Can I increase my coverage later?

You can request to increase your coverage later with Simplified Issue underwriting. If approved, you will be issued a second life insurance policy based on your current (attained) age.

For employees through age 70, if one elects any amount of life insurance during this initial enrollment, one can apply for additional coverage in $25,000 increments of life insurance, which includes $50,000 LTC with no health questions annually (up to the GI limits) if still actively at work for Enercon. Cumulative amounts are up to the $150,000 in life insurance and subject to guarantee issue maximum ages and limits.

What if I enroll in the plan and I change my mind?

The Certificate holder may, within 30 days after the Certificate is delivered, return the Certificate to the Carrier’s Administrative Office, and receive a full refund of any premiums that have been paid. Once returned, the Certificate will be void from its beginning.

Can the plan provide LTC benefits for care provided by unlicensed/informal caregivers such as family or friends?

Care must be provided by licensed professional providers.

What is the Elimination Period under the Long Term Care Benefit?

Means the number of days at the beginning of a Period of Care for which benefits are not payable under this Rider. In order for a day to count as a day in the Elimination Period, the following requirements must be met:

1. The Insured must be Chronically Ill; and
2. Charges must be incurred for the care and services of the Insured.

The elimination period needs to be satisfied only once during the Insured’s lifetime.

What are the Long Term Care Benefit Triggers?

You must satisfy the Elimination Period before benefits are paid. Each day the Insured is Chronically Ill, and charges are incurred for the care and service of the insured, one day of the Elimination Period will be satisfied.

Chronically Ill means certified by Licensed Health Care Practitioner as:

1. being unable to perform, without substantial assistance from another individual, at least 2 Activities of Daily Living (ADLs) for at least 90 days due to a loss of functional capacity or
2. requiring substantial supervision for protection from threats to health and safety due to Severe Cognitive Impairment.

Activities of Daily Living (ADLs) include: Bathing, Dressing, Continence, Eating, Toileting and Transferring

Where does the plan pay for care?

If you qualify for LTC benefits, where you receive care is up to you (e.g., Home Care, Assisted Living/Memory Care, Adult Day Care or Skilled Nursing Homes).

Will the plan pay for care outside of the US?

The plan will pay LTC benefits for care or services received in the United States or its territories only. Death benefits are paid anywhere in the world.