HomeMy WebLinkAboutRESPONSE - RFP - P902 BENEFITSProposal for
The City of Fort Collins
Voluntary Long Term Care
TransCare Options
Presented by:
Christi Johnson
Broker - Proffitt Benefit Services
5250 E Arapahoe Rd
F7-209
Centennial, CO
Toll Free 1-866-796-9471
And
Transamerica Occidental Life Insurance Company
General Agent — Colorado Group Brokerage
Denver, CO.
Mr. James B. O'Neill II, CPPO, FNIGP
The City of Fort Collins
Purchasing Department
215 North Mason St, 2nd Floor
Reference RFP P902
PO Box 580
Fort Collins, CO 80522
Dear Mr. O'Neill,
Transamerica does not have any specific written performance guarantees, other than their
reputation and a strong financial history. The number of group cases they have (2,698) bears
evidence to their unwritten commitment to performing excellent customer service and claims
payment.
Proffitt Benefit Services believes we are in partnership with our clients, a partnership of
commitment. A commitment of whatever time is needed to provide information and act as an
advocate on behalf of our clients. We provide a toll free number, e-mail access and 24-hour
response to client concerns and questions. One of our best references in regard to our
commitment to our clients and their employees would be your own benefits department.
Sincerely,
a
Christi Johnson
Proffitt Benefit Services
5250 E Arapahoe Rd
F7-209
Centennial, CO 80122
1-866-796-9471
Transamerica - Financial Overview
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Home : Company Profile : About Transamerica
Financial Overview
Financial Overview I Transamerica History I
About Transamerica Insurance & Investment Group
Financial Overview
Transamerica's life insurance subsidiaries have sterling
reputations for fiscal responsibility, integrity, and Financial
strength.
High Industry Ratings
Our consistently high ratings are a direct reflection of the care
with which we manage our business. Transamerica's life
Insurance subsidiaries have received high ratings from the
industry's most respected independent rating services.
Financial Strength Ratings for Transamerica Occidental Life
Insurance Company, Transamerica Life Insurance and Annuity
Company, and Transamerica Financial Life Insurance Company.
Agency
Rating*
Description
A.M. Best
A+
Superior
Standard & Poor's
AA
Very Strong
Moody's
Aa3
Excellent
Fitch
AA+
Very Strong
-Ratings as of April 2003
Ratings shown represent current and Independent opinions from the
leading providers of ratings of Insurance companies. After evaluating
a company's financial condition and operating performance, these
agencies assign ratings of a company's financial strength and ability
to meet obligations to policyholders. A.M. Best's A+ rating is the
second highest of 16 ratings; Standard & Poor's AA rating is the third
highest of 21 ratings; Moody's Aa3 rating is the fourth highest of 21
ratings; Fitch's AA+ rating Is the second highest of 24 ratings.
Financial Strength
The following figures are for Transamerica Occidental Life
Insurance Company (TOLIC) and Transamerica Life Insurance
and Annuity Company (TALIAC) as of December 31, 2002.
(in billions)
TOLIC
TALIAC
Life Insurance In Force
$495.5
$0.1
Total Assetsl
$24.1
$23.2
Total Liabilities
$21.6
$22.1
Statutory Surplus
$2.5
$1.1
IThese figures are reported on a statutory basis, as prescribed by
the National Association of Insurance Commissioners. The Asset
Valuation Reserve Is excluded from Total Liabilities and is included in
Statutory Surplus.
Transamerica Occidental Life Insurance Company,
Transamerica Life Insurance and Annuity Company, and
Transamerica Financial Life Insurance Company are members
of the AEGON Insurance Group, based in The Hague, The
Netherlands. For additional information about AEGON, please
visit www.aegon.com.
Top of Page
Privacy Policy & Terms of Use I Customer Privacy Notice I Company Directory
Resources
101 AEGON 2002 Annual
Report
02003 Transamerica Corporation. All Rights Reserved.
1 of 1
8/26/2003 10:00 PM
Contents of Section Eight
1. Checklist
2. Proposal Specifics
Side by side product outline.
Rates, with Plan Outline
There are 2 sheets for each of the three plans, one for single and one for married.
Each rate sheet provides the 5 Benefit Increase Options (BIO)
No BIO
GPO — Guarantee Purchase Option
Step -Rated — Provides for lower premium in early years
Simple Interest at 5%
Compound Interest at 5%
3. Implementation Timeline
4. Sample Policy
CHECKLIST OF ITEMS INCLUDED WITH PROPOSAL
Yes No Description of Item
l✓
Signature of Authorized
Proposal for Group Life Insurance, AD&D and Supplemental Life
Proposal for Group Voluntary Life
Proposal for Voluntary Group Life and AD&D
Proposal for Group Long Term Disability
Proposal for Group Dental
Proposal for Vision Care
Proposal for Transplant Coverage
Proposal for Long Term Care
Signed Proposal Compliance Letter
Signed Plan Design Confirmation
Completed and Signed Questionnaire(s)
Dental Network Access Analysis (if applicable)
Vision Network Access Analysis (if applicable)
Copy of your EOB for Dental and/or Vision Services (if applicable)
Proposed Implementation Timeline for The City.
Audited Financial Statements and/or Department of Insurance
filings for the past two years (Only if requested by The City)
Provider "Report Cards" used to provide feedback on clinical and
non -clinical performance measures
Copy of your Policy Assuring Member Satisfaction
Samples of all Standard and Optional Reports you are proposing
to provide on an account specific basis
Copy of your Banking Services Agreement
Copy of your Customer Satisfaction Survey
Copy of your Insurance
Contract that will be in effect January 1, 2004
City of Fort Collins, RFP 2003 11
PLAN DESIGNS
Benefit Structure
Plan A
Plan B
Plan C
Maximum Daily Benefit
$ 60.00
$ 120.00
$ 150.00
Benefit Period
4 Year
6 Year
Lifetime
Elimination Period
60 Day
60 Day
30 Da
Maximum Benefit in Pool
$87,600.00
$262,800.00
Unlimited
Coverage Amounts
100% NH
100% NH
100% NH
NH — Nursing Home
50% AL
100% AL
100% AL
AL — Assisted Living
50% HHC
50% HHC
100% HHC
HHC — Home Health Care
Discounts Available
Worksite 10%
Worksite 10%
Worksite 10%
The worksite discount is available
Preferred
Preferred
Preferred
because the City sponsors the plan.
20%
20%
20%
The discount is provided to all eligible
Married
Married
Married
individuals.
40%
40%
40%
Rate Guarantee
3 Years
3 Years
3 Years
Standard Benefits Included
All
All
All
Waiver of Premium
NH Bed Reservation
Hospice
Contingent Nonforfeiture
Care Coordination Benefit
All
All
All
Monthly Home Care
Respite Care
Therapeutic Device
Home Modifications
Medical Alert System
Care Giver Training
Benefit Increase
Individual Choice
Individual Choice
Individual
Option (BIO)
Choice
Simple — Automatic 5%
May choose no
May choose no
Compound — Automatic 5%
BIO or any of those
BIO or any of those
May choose no
Step -Rated — Increase annually by 5%
listed.
listed.
BIO or any of
each year until you reach the level
those listed.
desired.
Guaranteed Purchase — Offer the right to
purchase additional coverage without
evidence of insurability.
Payment Options
Payroll Deduct
Payroll Deduct
Payroll Deduct
Annual
Annual
Annual
Limited Pay
Limited Pay
Limited Pa
TransCare Options for the Worksite
Presentation prepared especially for
City of Fort Collins
Presented by: Christi Johnson
100% Nu. _ __.g Home, 50% Assisted Living, and 50% Home Health Care Coverage
4 Year Benefit Period, $87,600.00 Maximum Benefit, 60 Day Elimination Period,
$60 Maximum Daily Benefit
Lifetime Premium Paying Period, 3 Year Rate Guarantee
10% Worksite Discount
Monthly Premium Cost per Person
Voluntary Premium Rates for Plan A Displayed
by 1310 Option
Age
Voluntary Single Preferred Rates
Voluntary Single Standard
Rates
Step -Rated
Simple
Compound
Step -Rated
Simple
Compound
No BIO
GPO
BIO
BIO
BIO
No BIO
GPO
BIO
BIO
BIO
1840
$12.06
$12.18
$16.52
$22.18
$39.80
$15.08
$15.23
$20.66
$27.74
$49.75
41
$12.71
$12.84
$17.42
$23.39
$41.33
$15.90
$16.06
$21.78
$29.25
$51.67
42
$13.37
$13.50
$18.31
$24.58
$42.78
$16.71
$16.88
$22.89
$30.74
$53.47
43
$14.02
$14.16
$19.21
$25.80
$44.30
$17.52
$17.70
$24.01
$32.25
$55.37
44
$14.67
$14.82
$20.11
$26.85
$45.62
$18.34
$18.52
$25.11
$33.56
$57.03
45
$15.64
$15.80
$21.27
$28.62
$48.02
$19.56
$19.76
$26.60
$35.80
$60.06
46
$16.30
$16.46
$22.17
$29.67
$49.41
$20.38
$20.58
$27.72
$37.09
$61.74
47
$16.96
$17.12
$23.05
$30.84
$50.51
$21.19
$21.40
$28.82
$38.56
$63.14
48
$17.60
$17.78
$23.94
$31.87
$51.95
$22.01
$22.23
$29.94
$39.83
$64.92
49
$18.59
$18.78
$25.28
$33.65
$54.27
$23.22
$23.45
$31.58
$42.03
$67.82
50
$19.23
$19.42
$26.17
$34.62
$55.58
$24.04
$24.28
$32.69
$43.28
$69.48
51
$20.22
$20.42
$27.50
$36.40
$57.62
$25.27
$25.52
$34.38
$45.49
$72.02
52
$20.86
$21.07
$28.37
$37.56
$58.84
$26.09
$26.35
$35.49
$46.96
$73.56
53
$22.16
$22.38
$29.93
$39.68
$61.60
$27.72
$28.00
$37.42
$49.61
$77.05
54
$23.47
$23.70
$31.45
$41.78
$64.08
$29.35
$29.64
$39.32
$52.23
$80.12
55
$24.47
$24.71
$32.79
$43.55
$65.80
$30.57
$30.88
$40.97
$54.42
$82.25
56
$25.76
$26.02
$34.25
$45.59
$67.99
$32.20
$32.52
$42.83
$56.99
$85.00
57
$27.06
$27.33
$35.73
$47.91
$70.36
$33.82
$34.16
$44.65
$59.87
$87.94
58
$28.03
$28.31
$36.72
$49.33
$71.20
$35.05
$35.40
$45.91
$61.69
$89.03
59
$29.34
$29.63
$38.13
$51.05
$72.77
$36.68
$37.05
$47.68
$63.82
$90.96
60
$30.31
$30.61
$38.81
$52.45
$73.67
$37.91
$38.29
$48.53
$65.57
$92.11
61
$31.62
$31.94
$40.16
$54.39
$74.94
$39.53
$39.93
$50.20
$67.99
$93.67
62
$32.60
$32.93
$41.08
$55.75
$75.31
$40.75
$41.16
$51.35
$69.68
$94.14
63
$35.86
$36.22
$44.83
$60.62
$80.69
$44.83
$45.28
$56.04
$75.77
$100.88
64
$39.44
$39.83
$48.90
$66.27
$85.99
$49.31
$49.80
$61.15
$82.84
$107.50
65
$42.70
$43.13
$52.10
$70.89
$90.53
$53.38
$53.91
$65.13
$88.61
$113.18
66
$46.29
$46.75
$56.02
$76.38
$94.90
$57.87
$58.45
$70.02
$95.48
$118.63
67
$49.56
$50.06
$59.46
$80.78
$98.62
$61.95
$62.57
$74.34
$100.97
$123.27
68
$55.42
$55.97
$65.95
$89.22
$106.96
$69.28
$69.97
$82.45
$111.54
$133.71
69
$60.97
$61.58
$71.34
$96.32
$114.01
$76.21
$76.97
$89.17
$120.41
$142.52
70
$66.83
$67.50
$77.53
$103.59
$121.62
$83.55
$84.39
$96.91
$129.49
$152.05
71
$72.38
$73.10
$82.50
$110.01
$127.39
$90.47
$91.37
$103.14
$137.51
$159.22
72
$78.24
$79.02
$88.41
$117.37
$133.01
$97.80
$98.78
$110.51
$146.71
$166.26
73
$89.66
$90.56
$100.41
$131.80
$148.82
$112.08
$113.20
$125.53
$164.75
$186.05
74
$101.07
$102.08
$112.18
$146.55
$163.73
$126.33
$127.59
$140.21
$183.18
$204.65
75
$112.47
$113.59
$123.73
$160.84
$176.59 1
$140.58
$141.99
$154.65
$201.04
$220.71
State: CO
These rates are for illustration purposes only.
TCW ILL CO 403 Page 1 of 7 Date: 08/21/2003
TransCare Options for the Worksite
Presentation prepared especially for
City of Fort Collins
Presented by: Christi Johnson
100% Nu. _ _.,g Home, 50% Assisted Living, and 50% Home Health Care Coverage
4 Year Benefit Period, $87,600.00 Maximum Benefit, 60 Day Elimination Period,
$60 Maximum Daily Benefit
Lifetime Premium Paying Period, 3 Year Rate Guarantee
10% Worksite Discount
Monthly Premium Cost per Person
Voluntary Premium Rates for Plan A* Displayed
by 1310 Option
Age
Voluntary Married Preferred Rates
Voluntary Married Standard Rates
Step -Rated
Simple
Compound
Step -Rated
Simple
Compound
No BIO
GPO
BIO
BIO
BIO
No BIO
GPO
BIO
BIO
BIO
18-40
$7.00
$7.07
$9.59
$12.88
$23.10
$8.74
$8.83
$11.98
$16.09
$28.86
41
$7.38
$7.45
$10.11
$13.58
$24.00
$9.21
$9.30
$12.62
$16.95
$29.95
42
$7.77
$7.85
$10.64
$14.28
$24.84
$9.69
$9.79
$13.28
$17.82
$31.00
43
$8.13
$8.21
$11.14
$14.97
$25.71
$10.16
$10.26
$13.92
$18.69
$32.11
44
$8.52
$8.61
$11.66
$15.58
$26.47
$10.64
$10.75
$14.56
$19.46
$33.08
45
$9.09
$9.18
$12.36
$16.63
$27.91
$11.35
$11.46
$15.44
$20.77
$34.83
46
$9.46
$9.55
$12.87
$17.22
$28.67
$11.82
$11.94
$16.08
$21.52
$35.82
47
$9.83
$9.93
$13.38
$17.90
$29.32
$12.29
$12.41
$16.71
$22.37
$36.61
48
$10.22
$10.32
$13.90
$18.50
$30.15
$12.76
$12.89
$17.36
$23.10
$37.63
49
$10.78
$10.89
$14.66
$19.53
$31.50
$13.48
$13.61
$18.33
$24.39
$39.34
50
$11.16
$11.27
$15.18
$20.09
$32.27
$13.96
$14.10
$18.97
$25.11
$40.32
51
$11.74
$11.86
$15.95
$21.12
$33.44
$14.66
$14.81
$19.94
$26.39
$41.77
52
$12.12
$12.24
$16.47
$21.81
$34.16
$15.12
$15.27
$20.56
$27.23
$42.65
53
$12.86
$12.99
$17.35
$23.01
$35.76
$16.07
$16.23
$21.69
$28.77
$44.68
54
$13.61
$13.75
$18.24
$24.25
$37.19
$17.01
$17.18
$22.80
$30.28
$46.46
55
$14.19
$14.33
$19.01
$25.25
$38.17
$17.74
$17.92
$23.76
$31.57
$47.70
56
$14.95
$15.10
$19.87
$26.45
$39.45
$18.68
$18.87
$24.85
$33.07
$49.31
57
$15.70
$15.86
$20.73
$27.80
$40.83
$19.63
$19.83
$25.91
$34.73
$51.01
58
$16.27
$16.43
$21.31
$28.64
$41.33
$20.33
$20.53
$26.64
$35.78
$51.63
59
$17.03
$17.20
$22.14
$29.64
$42.24
$21.27
$21.48
$27.64
$37.01
$52.75
60
$17.59
$17.77
$22.52
$30.44
$42.76
$21.98
$22.20
$28.13
$38.03
$53.41
61
$18.34
$18.52
$23.30
$31.55
$43.47
$22.93
$23.16
$29.12
$39.43
$54.34
62
$18.92
$19.11
$23.83
$32.35
$43.71
$23.64
$23.88
$29.79
$40.41
$54.60
63
$20.81
$21.02
$26.02
$35.18
$46.83
$26.00
$26.26
$32.50
$43.95
$58.50
64
$22.88
$23.11
$28.37
$38.45
$49.89
$28.59
$28.88
$35.46
$48.03
$62.33
65
$24.79
$25.04
$30.23
$41.14
$52.55
$30.96
$31.27
$37.76
$51.39
$65.64
66
$26.87
$27.14
$32.51
$44.33
$55.08
$33.55
$33.89
$40.60
$55.37
$68.78
67
$28.75
$29.04
$34.50
$46.86
$57.21
$35.92
$36.28
$43.11
$58.56
$71.49
68
$32.17
$32.49
$38.28
$51.80
$62.09
$40.17
$40.57
$47.80
$64.68
$77.54
69
$35.37
$35.72
$41.39
$55.89
$66.15
$44.19
$44.63
$51.70
$69.83
$82.64
70
$38.79
$39.18
$45.00
$60.11
$70.59
$48.45
$48.93
$56.21
$75.09
$88.17
71
$42.01
$42.43
$47.89
$63.86
$73.94
$52.47
$52.99
$59.81
$79.75
$92.34
72
$45.40
$45.85
$51.31
$68.12
$77.19
$56.72
$57.29
$64.11
$85.08
$96.44
73
$52.04
$52.56
$58.28
$76.51
$86.38
$64.99
$65.64
$72.79
$95.52
$107.88
74
$58.65
$59.24
$65.10
$85.04
$95.01
$73.26
$73.99
$81.32
$106.22
$118.68
and Married discounts may apply. Married rates are only available if both spouses purchase identical coverage.
These rates are for illustration purposes only.
TCW ILL CO 403 Page 2 of 7 Date: 08/21/2003
TransCare Options for the Worksite
Presentation prepared especially for
City of Fort Collins
Presented by: Christi Johnson
Phone:(303)796-9471
100% Nu- _,g Home, 100% Assisted Living, and 100% Home Health Care Coverage
6 Year Benefit Period, $262,800.00 Maximum Benefit, 60 Day Elimination Period,
$120 Maximum Daily Benefit
Lifetime Premium Paying Period, 3 Year Rate Guarantee
10% Worksite Discount
Monthly Premium Cost per Person
Voluntary Premium Rates for Plan
B Displayed
by 1310 Option
Age
Voluntary Single Preferred Rates
Voluntary Single Standard
Rates
Step -Rated
Simple
Compound
Step -Rated
Simple
Compound
No BIO
GPO
BIO
BIO
BIO
No BIO
GPO
BIO
BIO
BIO
18-40
$43.85
$44.29
$60.07
$80.68
$144.74
$54.84
$55.39
$75.12
$100.91
$180.94
41
$46.24
$46.70
$63.36
$85.08
$150.26
$57.80
$58.38
$79.20
$106.37
$187.87
42
$48.60
$49.09
$66.59
$89.43
$155.51
$60.74
$61.35
$83.21
$111.76
$194.37
43
$50.98
$51.49
$69.84
$93.80
$161.09
$63.73
$64.37
$87.31
$117.26
$201.33
44
$53.32
$53.85
$73.05
$97.58
$165.83
$66.68
$67.35
$91.35
$122.02
$207.37
45
$56.90
$57.47
$77.39
$104.13
$174.65
$71.11
$71.82
$96.70
$130.12
$218.30
46
$59.28
$59.87
$80.61
$107.89
$179.60
$74.07
$74.81
$100.75
$134.81
$224.45
47
$61.64
$62.26
$83.82
$112.18
$183.69
$77.04
$77.81
$104.77
$140.21
$229.59
48
$64.01
$64.65
$87.07
$115.87
$188.85
$80.01
$80.81
$108.83
$144.81
$236.04
49
$67.56
$68.24
$91.88
$122.29
$197.28
$84.44
$85.28
$114.83
$152.83
$246.54
50
$69.93
$70.63
$95.10
$125.89
$202.12
$87.41
$88.28
$118.89
$157.33
$252.61
51
$73.49
$74.22
$99.95
$132.28
$209.43
$91.85
$92.77
$124.92
$165.34
$261.77
52
$75.85
$76.61
$103.17
$136.55
$213.90
$94.83
$95.78
$128.97
$170.67
$267.40
53
$80.62
$81.43
$108.85
$144.32
$224.09
$100.76
$101.77
$136.02
$180.36
$280.11
54
$85.34
$86.19
$114.36
$151.89
$232.96
$106.66
$107.73
$142.94
$189.87
$291.18
55
$88.89
$89.78
$119.10
$158.24
$239.09
$111.12
$112.23
$148.88
$197.79
$298.88
56
$93.65
$94.59
$124.56
$165.75
$247.23
$117.06
$118.23
$155.69
$207.20
$309.04
57
$98.38
$99.36
$129.87
$174.14
$255.79
$122.99
$124.22
$162.35
$217.67
$319.73
58
$101.94
$102.96
$133.56
$179.39
$258.89
$127.40
$128.67
$166.89
$224.26
$323.60
59
$106.67
$107.74
$138.66
$185.61
$264.54
$133.32
$134.65
$173.32
$231.97
$330.65
60
$110.25
$111.35
$141.13
$190.73
$267.92
$137.80
$139.18
$176.36
$238.39
$334.86
61
$114.96
$116.11
$146.01
$197.75
$272.49
$143.68
$145.12
$182.46
$247.13
$340.54
62
$118.53
$119.71
$149.36
$202.70
$273.81
$148.18
$149.66
$186.70
$253.38
$342.28
63
$130.40
$131.70
$163.01
$220.37
$293.41
$162.98
$164.61
$203.75
$275.45
$366.70
64
$143.42
$144.85
$177.83
$240.97
$312.63
$179.26
$181.05
$222.28
$301.15
$390.77
65
$155.28
$156.83
$189.44
$257.76
$329.18
$194.09
$196.03
$236.80
$322.19
$411.44
66
$168.29
$169.97
$203.64
$277.70
$345.03
$210.38
$212.48
$254.55
$347.11
$431.29
67
$180.17
$181.97
$216.20
$293.67
$358.54
$225.19
$227.44
$270.25
$367.07
$448.12
68
$201.49
$203.50
$239.79
$324.41
$388.87
$251.88
$254.40
$299.72
$405.53
$486.12
69
$221.64
$223.86
$259.32
$350.18
$414.45
$277.05
$279.82
$324.15
$437.75
$518.09
70
$242.97
$245.40
$281.85
$376.60
$442.22
$303.73
$306.77
$352.34
$470.80
$552.80
71
$263.15
$265.78
$299.97
$399.96
$463.13
$328.91
$332.20
$374.97
$499.92
$578.87
72
$284.46
$287.30
$321.43
$426.69
$483.57
$355.59
$359.15
$401.83
$533.38
$604.51
73
$325.96
$329.22
$365.08
$479.15
$541.10
$407.44
$411.51
$456.32
$598.93
$676.33
74
$367.47
$371.14
$407.89
$532.81
$595.30
$459.29
$463.88
$509.80
$665.99
$744.06
75 1
$408.92
$413.01
$449.82
$584.75
$641.98 1
$511.14
$516.25
$562.25
$730.91
$802.50
State: CO
These rates are for illustration purposes only.
TCW ILL CO 403 Page 3 of 7 Date: 08/21/2003
TransCare Options for the Worksite
Presentation prepared especially for
City of Fort Collins
Presented by: Christi Johnson
Phone:(303)796-9471
100% Nu:. .g Home, 100% Assisted Living, and 100% Home Health Care Coverage
6 Year Benefit Period, $262,800.00 Maximum Benefit, 60 Day Elimination Period,
$120 Maximum Daily Benefit
Lifetime Premium Paying Period, 3 Year Rate Guarantee
10% Worksite Discount
Monthly Premium Cost per Person
Voluntary
Premium Rates for Plan B* Displayed
by B10 Option
Age
Voluntary Married Preferred Rates
Voluntary Married Standard
Rates
Step -Rated
Simple
Compound
Step -Rated
Simple
Compound
No BIO
GPO
BIO
BIO
BIO
No BIO
GPO
BIO
BIO
BIO
18-40
$25.45
$25.70
$34.88
$46.84
$83.99
$31.79
$32.11
$43.56
$58.49
$104.93
41
$26.83
$27.10
$36.76
$49.36
$87.21
$33.50
$33.83
$45.90
$61.66
$108.90
42
$28.22
$28.50
$38.66
$51.92
$90.26
$35.23
$35.58
$48.27
$64.83
$112.72
43
$29.59
$29.89
$40.53
$54.44
$93.48
$36.95
$37.32
$50.63
$67.99
$116.76
44
$30.96
$31.27
$42.40
$56.65
$96.28
$38.65
$39.04
$52.96
$70.74
$120.23
45
$33.01
$33.34
$44.91
$60.43
$101.35
$41.23
$41.64
$56.08
$75.46
$126.61
46
$34.40
$34.74
$46.80
$62.63
$104.22
$42.96
$43.39
$58.42
$78.19
$130.18
47
$35.77
$36.13
$48.65
$65.10
$106.60
$44.70
$45.15
$60.78
$81.34
$133.16
48
$37.15
$37.52
$50.54
$67.23
$109.58
$46.41
$46.87
$63.13
$84.01
$136.91
49
$39.21
$39.60
$53.33
$70.97
$114.48
$48.96
$49.45
$66.58
$88.62
$142.98
50
$40.59
$41.00
$55.21
$73.07
$117.28
$50.68
$51.19
$68.94
$91.24
$146.49
51
$42.65
$43.08
$57.99
$76.76
$121.53
$53.26
$53.79
$72.43
$95.89
$151.80
52
$44.02
$44.46
$59.85
$79.22
$124.13
$54.99
$55.54
$74.80
$98.98
$155.08
53
$46.77
$47.24
$63.15
$83.72
$13Q.05
$58.43
$59.01
$78.89
$104.60
$162.43
54
$49.52
$50.02
$66.34
$88.13
$135.21
$61.85
$62.47
$82.87
$110.08
$168.86
55
$51.59
$52.11
$69.14
$91.84
$138.76
$64.44
$65.08
$86.36
$114.71
$173.34
56
$54.35
$54.89
$72.30
$96.22
$143.49
$67.89
$68.57
$90.30
$120.13
$179.21
57
$57.09
$57.66
$75.36
$101.05
$148.43
$71.31
$72.02
$94.14
$126.22
$185.42
58
$59.16
$59.75
$77.49
$104.12
$150.24
$73.89
$74.63
$96.81
$130.05
$187.67
59
$61.90
$62.52
$80.48
$107.72
$153.52
$77.33
$78.10
$100.53
$134.54
$191.77
60
$63.97
$64.61
$81.90
$110.68
$155.49
$79.92
$80.72
$102.31
$138.26
$194.18
61
$66.72
$67.39
$84.74
$114.76
$158.12
$83.33
$84.16
$105.83
$143.33
$197.52
62
$68.78
$69.47
$86.66
$117.61
$158.89
$85.92
$86.78
$108.27
$146.91
$198.49
63
$75.69
$76.45
$94.62
$127.91
$170.29
$94.51
$95.46
$118.15
$159.72
$212.67
64
$83.24
$84.07
$103.21
$139.84
$181.46
$103.95
$104.99
$128.91
$174.64
$226.62
65
$90.11
$91.01
$109.94
$149.60
$191.03
$112.56
$113.69
$137.32
$186.82
$238.61
66
$97.68
$98.66
$118.21
$161.19
$200.24
$122.02
$123.24
$147.65
$201.33
$250.14
67
$104.55
$105.60
$126.45
$170.43
$208.06
$130.62
$131.93
$156.76
$212.91
$259.93
68
$116.94
$118.11
$139.17
$188.28
$225.68
$146.06
$147.52
$173.80
$235.15
$281.88
69
$128.62
$129.91
$150.50
$203.23
$240.55
$160.67
$162.28
$188.00
$253.86
$300.46
70
$140.99
$142.40
$163.54
$218.54
$256.62
$176.13
$177.89
$204.32
$273.01
$320.54
71
$152.71
$154.24
$174.09
$232.11
$268.77
$190.74
$192.65
$217.44
$289.94
$335.72
72
$165.07
$166.72
$186.57
$247.63
$280.62
$206.20
$208.26
$233.00
$309.31
$350.54
73
$189.15
$191.04
$211.86
$278.07
$313.99
$236.27
$238.63
$264.63
$347.33
$392.21
74
$213.22
$215.35
$236.66
$309.17
$345.43
$266.35
$269.01
$295.65
$386.22
$431.48
75
$237.30
$239.67
$261.03
$339.35
$372.56
$296.43
$299.39
$326.08
$423.90
$465.39
*Preferred and Married discounts may apply. Married rates are only available if both spouses purchase identical coverage. State: CO
These rates are for illustration purposes only.
TCW ILL CO 403 Page 4 of 7 Date: 08/21/2003
TransCare Options for the Worksite
Presentation prepared especially for
City of Fort Collins
Presented by: Christi Johnson
Phone:
100% Nu_ g Home, 100% Assisted Living, and 100% Home Health Care Coverage
Lifetime Benefit Period, Unlimited Maximum Benefit, 30 Day Elimination Period,
$150 Maximum Daily Benefit
Lifetime Premium Paying Period, 3 Year Rate Guarantee
10% Worksite Discount
Monthly Premium Cost per Person
Voluntary Premium Rates for Plan C Displayed
by BIO Option
Age
Voluntary Single Preferred Rates
Voluntary Single Standard
Rates
Step -Rated
Simple
Compound
Step -Rated
Simple
Compound
No BIO
GPO
BIO
BIO
BIO
No BIO
GPO
BIO
BIO
BIO
18-40
$66.67
$67.34
$91.36
$122.70
$220.05
$83.37
$84.20
$114.21
$153.41
$275.12
41
$70.40
$71.10
$96.47
$129.56
$228.83
$87.98
$88.86
$120.52
$161.90
$285.99
42
$74.10
$74.84
$101.52
$136.34
$237.10
$92.61
$93.54
$126.88
$170.39
$296.35
43
$77.79
$78.57
$106.57
$143.13
$245.82
$97.24
$98.21
$133.19
$178.93
$307.28
44
$81.52
$82.34
$111.66
$149.15
$253.51
$101.87
$102.89
$139.56
$186.46
$316.87
45
$85.22
$86.07
$115.89
$155.94
$261.61
$106.51
$107.58
$144.84
$194.92
$326.98
46
$88.92
$89.81
$120.93
$161.83
$269.42
$111.16
$112.27
$151.18
$202.31
$336.78
47
$92.65
$93.58
$126.03
$168.62
$276.10
$115.82
$116.98
$157.52
$210.77
$345.14
48
$96.32
$97.28
$131.00
$174.34
$284.15
$120.42
$121.62
$163.77
$217.95
$355.20
49
$100.03
$101.03
$136.02
$181.05
$292.09
$125.03
$126.28
$170.03
$226.32
$365.10
50
$103.72
$104.76
$141.04
$186.69
$299.72
$129.66
$130.96
$176.33
$233.38
$374.71
51
$107.43
$108.50
$146.10
$193.40
$306.21
$134.30
$135.64
$182.61
$241.73
$382.72
52
$111.14
$112.25
$151.14
$200.04
$313.40
$138.93
$140.32
$188.95
$250.06
$391.75
53
$114.85
$116.00
$155.05
$205.55
$319.23
$143.55
$144.99
$193.80
$256.93
$399.05
54
$118.56
$119.75
$158.88
$211.05
$323.64
$148.17
$149.65
$198.57
$263.77
$404.53
55
$120.42
$121.62
$161.37
$214.34
$323.91
$150.51
$152.02
$201.69
$267.90
$404.86
56
$124.13
$125.37
$165.10
$219.68
$327.69
$155.11
$156.66
$206.31
$274.57
$409.52
57
$127.79
$129.07
$168.67
$226.19
$332.26
$159.73
$161.33
$210.86
$282.74
$415.34
58
$138.93
$140.32
$181.99
$244.48
$352.87
$173.64
$175.38
$227.46
$305.60
$441.04
59
$150.04
$151.54
$195.04
$261.05
$372.10
$187.54
$189.42
$243.79
$326.32
$465.07
60
$162.97
$164.60
$208.60
$281.93
$396.01
$203.72
$205.76
$260.77
$352.43
$495.03
61
$174.13
$175.87
$221.15
$299.50
$412.68
$217.65
$219.83
$276.41
$374.36
$515.84
62
$185.23
$187.08
$233.38
$316.73
$427.86
$231.53
$233.85
$291.73
$395.93
$534.87
63
$205.60
$207.66
$257.00
$347.45
$462.62
$257.02
$259.59
$321.26
$434.37
$578.28
64
$224.12
$226.36
$277.91
$376.52
$488.57
$280.15
$282.95
$347.39
$470.65
$610.70
65
$244.49
$246.93
$298.29
$405.86
$518.31
$305.62
$308.68
$372.85
$507.32
$647.90
66
$264.90
$267.55
$320.53
$437.08
$543.05
$331.07
$334.38
$400.61
$546.26
$678.71
67
$283.38
$286.21
$340.05
$461.93
$563.93
$354.25
$357.79
$425.11
$577.44
$704.94
68
$318.59
$321.78
$379.15
$512.94
$614.89
$398.24
$402.22
$473.91
$641.17
$768.60
69
$351.95
$355.47
$411.75
$556.07
$658.13
$439.91
$444.31
$514.70
$695.08
$822.67
70
$387.10
$390.97
$449.02
$600.02
$704.50
$483.88
$488.72
$561.30
$750.01
$880.65
71
$420.44
$424.64
$479.32
$639.07
$739.98
$525.58
$530.84
$599.17
$798.88
$925.02
72
$453.81
$458.35
$512.80
$680.71
$771.48
$567.26
$572.93
$641.00
$850.89
$964.34
73
$537.16
$542.53
$601.62
$789.64
$891.69
$671.42
$678.13
$751.99
$986.98
$1,114.57
74
$620.49
$626.70
$688.76
$899.72
$1.005.18
$775.61
$783.37
$860.95
$1.124.62
$1.256.48
75 1
$703.83
$710.87
$774.21
$1,006.48
$1,105.01
1 $879.79
$888.59
$967.76
$1,258.08
$1,381.29
State: Co
These rates are for illustration purposes only.
TCW ILL CO 403 Page 5 of 7 Date: 08/21/2003
1*14X411119M1**II]aMMC'l'1
The City of Fort Collins began offering Voluntary LTC through Proffitt Benefit Services
in November 1996. The decision to offer this product was made in order to offer the employees
protection for potential post -retirement expenses.
The original offering was Lifecare 2000 through First Penn/Lincoln National. There are
21 employee/spouse policies still in effect with the Lifecare 2000 product. In September of
2001 the decision was made to offer a traditional LTC product. Transamerica was chosen
because it provided the following:
Discounts for employees and their extended families,
Three plans, each providing for a different type of planning choice,
A Tax Qualified policy,
Contract provisions,
Competitive rates,
Strong financial and service background, and most importantly,
Coverage for uninsurable employees during initial enrollment.
Proffitt Benefit Services works to make the process one of fully educating employees to
assist them in making an informed decision. We accomplish this by:
Providing educational seminars,
Being available during the majority of open enrollment,
Using a consulting sales process,
Answering questions by e-mail, phone or mail, and
Providing www.itcworksite.com/iohnson as an educational opportunity.
The three plans provided in this proposal are the 3 plans originally chosen to offer to the
employees. Detailed information on the plans and the rates are provided in Section Eight. There
are no additional charges to the City for providing the plan.
Proffitt Benefit Services letterhead contains these words,
SERVICE — Our Goal, Your Guarantee.
This is a commitment we do not make lightly. It is a commitment of whatever time is needed to
provide information and act as an advocate on behalf of our clients. It is a commitment to a
partnership with our clients. We are in close contact with the individuals with whom we work at
the City, our other clients and their employees. We provide a toll free number, e-mail access and
24-hoar response to client concerns and questions. One of our best references in regard to our
commitment to our clients and their employees would be your own benefits department.
TransCare Options for the Worksite
Presentation prepared especially for
City of Fort Collins
Presented by: Christi Johnson
Phone:(303)796-9471
100% Nu_ ..g Home, 100% Assisted Living, and 100% Home Health Care Coverage
Lifetime Benefit Period, Unlimited Maximum Benefit, 30 Day Elimination Period,
$150 Maximum Daily Benefit
Lifetime Premium Paying Period, 3 Year Rate Guarantee
10% Worksite Discount
Monthly Premium Cost per Person
Voluntary
Premium Rates for Plan C* Displayed
by 1310 Option
Age
Voluntary Married Preferred Rates
Voluntary Married Standard Rates
Step -Rated
Simple
Compound
Step -Rated
Simple
Compound
No BIO
GPO
BIO
BIO
BIO
No BIO
GPO
BIO
BIO
BIO
18-40
$38.70
$39.09
$53.01
$71.21
$127.70
$48.31
$48.79
$66.20
$88.92
$159.48
41
$40.85
$41.26
$55.97
$75.17
$132.76
$51.02
$51.53
$69.92
$93.89
$165.89
42
$43.00
$43.43
$58.91
$79.13
$137.62
$53.72
$54.26
$73.61
$98.85
$171.94
43
$45.13
$45.58
$61.83
$83.06
$142.65
$56.39
$56.95
$77.27
$103.74
$178.22
44
$47.31
$47.78
$64.81
$86.56
$147.13
$59.09
$59.68
$80.97
$108.13
$183.76
45
$49.45
$49.94
$67.24
$90.50
$151.82
$61.76
$62.38
$83.99
$113.04
$189.60
46
$51.62
$52.14
$70.23
$93.94
$156.41
$64.45
$65.09
$87.64
$117.29
$195.28
47
$53.75
$54.29
$73.10
$97.82
$160.19
$67.17
$67.84
$91.36
$122.24
$200.16
48
$55.89
$56.45
$76.03
$101.16
$164.87
$69.83
$70.53
$94.97
$126.40
$205.97
49
$58.06
$58.64
$78.96
$105.11
$169.53
$72.52
$73.25
$98.63
$131.27
$211.75
50
$60.19
$60.79
$81.84
$108.35
$173.96
$75.21
$75.96
$102.28
$135.35
$217.33
51
$62.36
$62.98
$84.81
$112.24
$177.72
$77.89
$78.67
$105.91
$140.19
$221.98
52
$64.49
$65.14
$87.70
$116.09
$181.86
$80.56
$81.37
$109.55
$145.01
$227.19
53
$66.65
$67.32
$89.99
$119.32
$185.30
$83.27
$84.10
$112.42
$149.06
$231.47
54
$68.79
$69.48
$92.17
$122.47
$187.78
$85.93
$86.79
$115.14
$152.95
$234.59
55
$69.86
$70.56
$93.61
$124.36
$187.97
$87.28
$88.15
$116.96
$155.38
$234.81
56
$72.04
$72.76
$95.82
$127.49
$190.16
$89.98
$90.88
$119.70
$159.26
$237.56
57
$74.17
$74.91
$97.89
$131.30
$192.81
$92.65
$93.58
$122.30
$163.98
$240.88
58
$80.60
$81.41
$105.59
$141.88
$204.73
$100.68
$101.69
$131.90
$177.23
$255.76
59
$87.07
$87.94
$113.18
$151.49
$215.92
$108.76
$109.85
$141.39
$189.27
$269.73
60
$94.58
$95.53
$121.08
$163.62
$229.83
$118.15
$119.33
$151.24
$204.39
$287.10
61
$101.06
$102.07
$128.36
$173.84
$239.52
$126.24
$127.50
$160.34
$217.11
$299.20
62
$107.48
$108.56
$135.43
$183.78
$248.28
$134.27
$135.61
$169.17
$229.61
$310.16
63
$119.30
$120.49
$149.14
$201.62
$268.44
$149.05
$150.54
$186.31
$251.88
$335.34
64
$130.04
$131.34
$161.25
$218.47
$283.51
$162.45
$164.07
$201.45
$272.93
$354.15
65
$141.88
$143.30
$173.09
$235.54
$300.80
$177.24
$179.01
$216.25
$294.22
$375.74
66
$153.74
$155.28
$186.04
$253.66
$315.14
$192.01
$193.93
$232.34
$316.82
$393.62
67
$164.47
$166.11
$197.37
$268.09
$327.29
$205.44
$207.49
$246.53
$334.87
$408.83
68
$184.88
$186.73
$220.00
$297.67
$356.82
$230.95
$233.26
$274.84
$371.82
$445.74
69
$204.25
$206.29
$238.96
$322.74
$381.93
$255.11
$257.66
$298.49
$403.08
$477.06
70
$224.65
$226.90
$260.60
$348.21
$408.87
$280.62
$283.43
$325.51
$434.97
$510.71
71
$243.99
$246.43
$278.16
$370.89
$429.45
$304.78
$307.83
$347.46
$463.27
$536.42
72
$263.36
$265.99
$297.61
$395.06
$447.73
$328.97
$332.26
$371.74
$493.47
$559.25
73
$311.72
$314.84
$349.12
$458.24
$517.45
$389.39
$393.28
$436.14
$572.42
$646.41
74
$360.09
$363.69
$399.71
$522.13
$583.33
$449.81
$454.31
$499.29
$652.22
$728.68
75 1
$408.47
$412.55
$449.30
$584.09
$641.30 1
$510.20
$515.30
$561.21
$729.60
$801.02
*Preferred and Married discounts may apply.
Married rates are only available if both spouses purchase identical coverage.
State: CO
these rates are for illustration purposes only.
TCW ILL CO 403 Page 6 of 7 Date: 08/21/2003
Disclaimer Information
A Word about Premium Rates
The Policy allows the company to adjust premiums as needed, with prior regulatory approval, if required in your state. We cannot increase your premiums during any applicable
rate guarantee period. If you purchase additional years of rate guarantee, the premium amount charged for the additional rate guarantee will be dropped at the expiration of the rate
guarantee period. When the rate guarantee period ends, your premium will be adjusted by any premium increases that may occur during the rate guarantee period. However, if you
purchase a limited pay plan with a matching rate guarantee period, your premiums will not be affected by any premium increases. We cannot single you out for a premium rate
increase, but we can change your premium based on our experience with all insureds in your same premium class. Once we issue your coverage, we cannot cancel your Policy as
long as you pay your premium on a timely basis.
This is an illustration only, not a contract. Actual coverage is subject to the terms and conditions of the Policy. Please see the accompanying Outline of Coverage and sales brochure
for a description of benefits, exclusions and limitations, as well as the terms under which the policy may continue in force. Premium and benefit amounts will vary, depending upon
the plan selected. The actual premium may differ as a result of any applicable discounts. In addition, the actual premium paid will be impacted by the premium payment mode
selected. Final premium amounts are subject to underwriting approval. The Schedule Page of your policy will reflect the actual premium.
Policy Number: TOL 1-FP 402
TCW ILL CO 403 Page 7 of 7 Date: 08/21/2003
City of Ft. Collins
Long Term Care
IMPLEMENTATION TIMELINE
August 18, 2003 Obtain Employee Census
August 20 Obtain Rates for Plans A, B, C
September 1 Update Education and Enrollment Website
September 15 Review implementation schedule with Gwen Feit
Schedule group/individual meetings
Set up phone, meeting rooms etc.
September 18 Attend City Health Fair
October 29 Attend department designee meeting
Hold first Education Seminar on LTC
November 3-14 Hold second education session on LTC
Attend employee group meetings
Hold individual employee sessions
December 5 Final date for Payroll Deduct applications
December 12 Provide billing contact with list of new deductions
January 1, 2004 Family and annual pay applications due
January Update payroll deduction information
January Policies delivered, as they are issued
January Bill reconciliation, upon receipt by HR
1 TRANSAMERICA
® O CC I D E N T A L L IF E
Transamerica Occidental
Life Insurance Company
Home Office: Cedar Rapids, Iowa
A Capital Stock Company
,inafter called: the Company, We, 0
Long Term Care Division
Administrative Office: P.O. Box 92106
Bedford, TX 76095-9106
14800) 227-3740
, or
This Policy is intended to be a qualified long term care insurance contract
the Internal Revenue Code of 1986, as amended.
THIS IS A LONG TERM CARE POLICY. PLEASE READ IT AP
We are pleased to issue this Policy to You. It has many important feature WeC
It is issued in exchange for Your application and payment of the Initial Pre
THIS POLICY IS GUARANTEED RENEWABLE FOR L'
Your timely payment of premiums is all that is needed to keep this Policy in fc
exhausted. We cannot cancel or refuse to renew this Policy if t emium is I
the Premium Paying Period, You must pay any premium due o or betthe
be received by Us at Our Administrative Office prior to the expirati oace
WE HAVE A RIGHT TO At
We can change Your premiums based on Your pr iu
of Insurance, if required. Premium class means po it
having similar characteristics, such as issue ag issue
options or other criteria. The change in pre ma c
expired and only during the Premium Pa ng Pe ' d sh
least 30 days written notice before We ch ge our m
a change in Your age or health.
section 770213(b) of
it carefully.
unt' benefits have been
onlime. To renew during
9m Due Date and it must
Rlass subjecTtb approval by the Department
gio segment classified by Our actuaries as
y r, rate classification, and selected benefit
mr I after the Rate Guarantee, if any, has
the Schedule. We must give You at
u Your premiums will not increase due to
30-D R GHME Ili YOUR POLICY
You have 30 days from the day You ceiv Policy o examine and return it to Us if You decide not to
keep it. You do not have to tell Us Your son r Wing the Policy. Simply return it, within 30 days of its
receipt, to Us at Our Administ 've Office, o the agent or office through which it was purchased and We
will refund the full amount of,�any pre ' aid a the Policy will be void from the start.
MP"T CAU ON ABOUT THE APPLICATION
The issuance of this Policy i bas up a answers to the questions on the application. A copy of the
application is attached. If any swe are incorrect or untrue, We may have the right to deny benefits or
rescind the Policy he est time o cl r up any question is now, before a claim arises! If, for any reason,
any of the answ rs rre in plete or untrue, contact Us at Our Administrative Office. Our address is
shown above. ur - roe numbe is shown on the Schedule page.
Notice to Buy • Thi olic m not cover all the costs associated with long term care incurred during the
period of coverage. Th buyer ' advised to review carefully all Policy limitations.
THIS POLICY IS NOT EDICARE SUPPLEMENT POLICY: If an Insured Person is eligible for Medicare,
review the Medicare Supplement Buyer's Guide available from Us.
Ex utivaL� a Vice
PraseK General Counsel
and Corporate Secretary Prasldo -Life I ura Division
LONG PERM CARE INSURANCE POLICY
GUARANTEED RENEWABLE
NON -PARTICIPATING
TOL 1-FP 402 FP-1 OPTIONS
OPTIONS
TABLE OF CONTENTS
SUBJECT Page
Guaranteed Renewable; Right to Change
Premiums...................................................... FP-1
Important Caution about the Application........ FP-1
Schedule.......................................................... S-1
General Provisions ........................................ GP-1
Effective Date, Premium Payment, and
Termination Provisions ................................ EPT-1
Claims Information ........................................... C-1
SUBJECT Page
General Exclusions and Limitations............ GEL-1
General Definitions .... ............................ GD-1
Eligibility Definif ns ..... ................ ............. ED-1
Benefit Eligibili ........ ................... BE-1
General Benefit Informa ` .................... GBI-1
B fit Sec ' ns
TOL 1-TC 1001 TC-1
OPTIONS
OPTIONS
SCHEDULE
Policy Number: 1234567601
Policyholder: John Doe
Premium Paying Mode: Quarterly
Initial Premium: $200.00
Our toll fri
Note: The
the Effecti
benefits ai
REQUIRE[
Benefits sL
Nursi
NH -
Assis
ALF -
HomE
Hosp
Resp
Maximum
Eliminatio
Benefits fc
Period.
Nursing F
M(
N1
Restoratic
Assisted
K
Al
Maximum Number of Days per Calendar Year
Home Health Care and Adult Day Care Benefits
Maximum Daily Professional Services Benefit
Maximum Daily Basic Services Benefit
Maximum Daily Adult Day Care Benefit
Hospice Care Benefit
Maximum Daily Benefit
Effective Date: 2/15/2020
Policyholder's Age: 72
Premium Paying Period: Lifetime
Mode Premium: $200.00
effective on
deletion of
2
Unlimited
90 Days
e Elimination
Included
$100.00
30 Days
Included
Included
$100.00
30 Days
Included
$100.00
$100.00
$100.00
Included
$100.00
TOL 1-S 1001 S-1 OPTIONS
Care Coordination Benefit
Maximum
Respite Care Benefit
Maximum Daily Benefit
Maximum Number of Days per Calendar Year
Thernnai e- navira Rannfi4
Home I
Modica
Caregl%
Monthly
Alternal
Full Re
Waiver
Joint A
Lifetime
Spouse
Simple
Compoi
Maximum Multiple
Step -Rated Compound Benefit Increase Option
Benefit Increase Percentage
Premium Increase Percentage
Premium Increase Frequency
Guaranteed Purchase Option
Included
Unlimited
Included
$100.00
30 Days
Included
$5,000.00
Included
$5,000.00
Included
$50.00
$5,000.00
Included
$1,000.00
Included
Included
$1,000.00
Imium $50.00
Included
imium $50.00
Included
180 Days
mium $50.00
mium $50.00
5%
mium $50.00
5%
2 Times
Elected - Premium $50.00
5%
5%
Every year on the
anniversary date of the Policy
Elected - Premium $50.00
TOL 1-S 1001 S-2 OPTIONS
Return of Premium
Elected -Premium $50.00
Full Return of Premium
Nonforfeiture Benefit
Contingent Nonforfeiture Benefit
Rate Guarant
Period
TOTAL PREN
TOTAL PREN
Elected - Premium $50.00
Elected - Premium $50.00
Included
Included
3 Years
$200.00
$500.00
TOL 1-S 1001 S-3 OPTIONS
Mr. James B. O'Neill II, CPPO, FNIGP
The City of Fort Collins
Purchasing Department
215 North Mason St, 2"d Floor
Reference RFP P902
PO Box 580
Fort Collins, CO 80522
Dear Mr. O'Neill,
Enclosed please find my response to your RFP in reference to Voluntary Long Term
Care. To the best of our ability I have provided the information requested in your RFP in the
format requested.
Proffitt Benefit Services has been working with the City of Fort Collins on the delivery of
Long Term Care as a voluntary offering since November 1996. We currently have 48 employees
covered on existing LTC policies. Additionally we have 13 spouses covered and other family
members either covered or waiting to be covered once health conditions resolve.
I welcome the opportunity to continue educating and assisting the employees of the City
of Fort Collins.
Sincerely,
Christi Johnson
Proffitt Benefi ervices
5250 E Arapahoe Rd
F7-209
Centennial, CO 80122
1-866-796-9471
OPTIONS
GENERAL PROVISIONS
This section describes: the documents that form this
contract; the importance of a truthful application; and
other basic rights and obligations.
THE CONTRACT
Entire Contract: The entire contract between You and
Us will consist of:
(1) this Policy; and
(2) the application; and
(3) any riders, endorsements or amendments made a
part of this Policy.
Modifications of Contract: No agent has authority to
change or waive any part of this Policy. To be valid,
any change or waiver must be:
(1) in writing; and
(2) approved by one of Our executive officers; and
(3) made a part of this Policy by Us.
After an Insured Person's coverage has been in force
for at least 2 years, We may only rescind the coverage
upon a showing that the person knowingly and
intentionally misrepresented relevant facts relating to his
or her health.
CORREY" OF MISTAKES
As hard as We try _ ke�sure We get things right,
We acknowledge ro a-t -time, mistakes will
happen. When e d _ n r mistake or You
bring it to Our aisn r the right to correct
it. We reserve th t;,_ rrect any errors or
mistakes We make whe he premium calculation
and tion process 'n t ` policy issue process, in
the nefit ment r s, or in some other aspect
of Our ntrac ref nship. The benefit selections
After this Policy is issued or reinstated, any rider or
endorsement must be accepted in writing by Y u,
unless We do not require Your acceptance or i th
change is required by law.
on
the ` ` plication and by any signature
ant used to determine what policy
should be issued. Premiums will be collected
those benefits You selected and purchased.
OTHER PROVISIONS
icipating: This Policy does not participate in Our
:s or surplus earnings.
MISSTATEMENT OF AGE
If the age of an Insured Person has bee Wvi
all onformity with Law: If anything in this Policy does not
benefits payable are those which the pre ' m comply with a law to which it is subject on its Effective
would have purchased at the correct age. If the tree Date, that provision is amended to conform to such
age exceeded the maximum ag at We wo law.
have issued this Policy, Our li ility all be lim to Time Periods: All time periods begin and end at 12:01
the refund of all premiums paid thi P cy. A.M. Standard time at Your Home.
Time Limit on Ce ain e . Wh�i Wan Insured
Person's coverag h een in -f ce less than 6
months, We may escind a ve age or deny an
otherwise valid claim i urred or disability
that starts before the en of th month period upon
a showing of misrepresentation that is material to Our
decision to issue You the coverage.
When an Insured Person's coverage has been in force
for at least 6 months but less than 2 years, We may
rescind the coverage or deny an otherwise valid claim
for a loss incurred or disability that starts before the
end of the 2 year period upon showing of
misrepresentation that is both material to Our decision
to issue You the coverage and which pertains to the
conditions for which benefits are sought.
TOL 1-GP 1001 GP-1 OPTIONS
EFFECTIVE DATE, PREMIUM PAYMENT AND
TERMINATION PROVISIONS
This section explains: when this Policy becomes
effective; how and when to pay premiums; the
importance of paying premiums on time; what happens
if premiums are not paid on time; and when this Policy
ends.
THE POLICY TAKING EFFECT
Effective Date and Consideration: This Policy is issued
based on the answers to the questions on the
application and payment of the Initial Premium. It takes
effect on the Effective Date shown on the Schedule,
provided the Initial Premium is paid. Any new benefit
added and any increase or decrease in benefit
amounts will be effective from the effective date shown
on the endorsement for such benefit addition, increase
or decrease.
PAYING PREMIUMS
After payment of the Initial Premium, each ai
premium, if any, is due at the end of the pe
which the prior premium was paid. The F
Paying Mode shown on the Schedule statepKk
premiums are to be paid. The Premium ; a -I-
You select will impact Your overall cost ins
The Premium Paying Period shown on the
states how long premiums are to; aid. Pr
are to be paid to Us at Our Ad nistrative
Any Rate Guarantee is only appli ble`fio th inal
Policy Effective Date. Any subsequ ' `chan swill not
have a Rate Guarante
WHAT HAPPENS HC�# PRE UM ARE NOT PAID
Grace Period: A G ce Pe ` d of 1 ays following the
Premium Due Date is a o or ` e payment of each
premium, if any, after th remium. During this
period, this Policy will remain in force. At the end of
the Grace Period, Your coverage will Lapse as of the
last Premium Due Date, subject to the Third Party
Notification provision.
Third Party Notification: If You have designated a third
party to be notified in the event Your premium is not
received by the end of the Grace Period, We will mail
a notice to the person(s) You have designated, as well
as to You. This Policy will not Lapse until 35 days
after the date on the notice We have mailed to You
and the third party. You have the right, at any time, to
change the third party to be notified by providing Us
with written notice of the change.
If You do not designate a third party to be notified in
the event Your premium is not received by the end of
the Grace Period, Your Policy will Lapse if We do not
receive the premium _ the Grace Period ends. If
You designate a th be notified in the event
Your premium is -' c y _:_ end of the Grace
Period, Your P if not receive the
premium within _ ate on the notice
We mail to the desio rtv.
G THI _; CY BACK IN FORCE
�_ Policy Lapses, We may or
p force (reinstate) at Our option.
�quir pplication for reinstatement, and if
:ation is approved by Us, this Policy will be
in force as of the Lapse date, upon payment
i-due premiums.
Ydtlrfstated Policy will only provide benefits for
sses that result from an Injury sustained after the
of reinstatement or Sickness that starts more than
days after such date. In all other respects, Your
rights and Our rights will be the same as before this
Policy Lapsed, unless there are special conditions that
apply to the reinstatement. If there are, they will be
endorsed on or attached to the reinstated Policy.
Unintentional Lapse: If Your Policy Lapses, We will
reinstate Your coverage if:
(1) We receive the request for reinstatement in Our
Administrative Office within 180 days of the last
Premium Due Date; and
(2) We receive Your Licensed Health Care
Practitioner's written certification that You were
diagnosed, using generally accepted medical
diagnostic methods and tests, with Cognitive
Impairment or as being unable to perform at least
the Required Number of Activities of Daily Living
shown on the Schedule at the time the Policy
Lapsed. It must be documented in Your Licensed
Health Care Practitioner's records that an event
had occurred prior to the Lapse that would have
resulted in a diagnosis of Cognitive Impairment or
inability to perform at least the Required Number of
Activities of Daily Living, which made You unable
to pay the premium; and
TOL 1-EPT 1001 EPT-1 OPTIONS
(3) We receive all past -due premiums for the benefits
that were in force at the time the Policy Lapsed.
Coverage will be continuous subject to these
requirements. Any claim incurred during the 180-day
period will be considered for benefits subject to all
other PoIICy nrnvicinnc
W
We will not
or end this
of mental or
Termination:
provision to
following:
(1) the date
(2) the date
(3) the da
exhausts
(4) the nex
receipt
coverage
for the
request
this Pol
anniver
cancella
Payment c
termination
Upon notific
Paying Perii
refund any
Paying PE
provisions
amount of
premiums F
refunded premiums to Your estate.
Should We receive a written request from You to
cancel this Policy, We will refund to You any premiums
paid which apply to the Premium Paying Period
following the Policy monthly anniversary on which the
Policy terminated.
TOL 1-EPT 1001 EPT-2 OPTIONS
CLAIMS INFORMATION
This section informs You of: when to tell Us of a
claim; what to send to Us; where to send it; how We
pay benefits; and other rights and obligations under
this Policy.
TELLING US OF A CLAIM
Notice of Claim: We must be noted in writing when
there is a claim for benefits. Notice must be received
by Us at Our Administrative Office within 60 days of
the date the covered loss starts. Failure to notify Us
within 60 days may result in claim denial if We are
prejudiced by the delay. The notice should include at
least: the claimant's name, Policy Number, and the
address to which the claim form should be sent.
Someone else may be authorized to act for the
claimant in filing a claim.
HOW TO FILE A CLAIM
Claim Forms: When We receive notice of a claim, We
will send out a claim form to be used to file Proof'af
Loss.'
The claim form has instructions on how t I it
and where to send it. Please read the fly'.
m car
Answer all questions and send all requi inf
to the address on the form. _
If the claimant or his representa ' e not get`tta\e
claim form within 15 days, Pro f of oss can d
without it by sending Us a left vah h scribes he
occurrence, the nature, and the a tV t loss for
which claim is made. T letter m t be sent to Us
within the time perio state in then t_p graph. At
a minimum, the de ri uld II such things
as: the claimantn e, s social security
number, and polic num th ty a of benefits for
which claim is being made, n." es and addresses
of the medical professio care providers who
are aware of the claimant's condition or have provided
care covered by this Policy; the diagnosis; and the
periods for which benefits are being claimed.
WHEN TO FILE A CLAIM
Proof of Loss: We must receive written Proof of Loss
within 90 days after the end of each month for which
benefits may be paid. If it was not reasonably possible
to give Us written proof in the time required, We will
not reduce or deny a claim for being late if the proof
is filed as soon as reasonably possible and as long as
We are not prejudiced by the delay. Unless the
claimant is not legally capable, the required proof must
always be given to Us no later than one year from the
time specified.
HOW AND W CLAIMS ARE PAID
Time of Payment _ ai After We receive the
proper written Pr L _ a ill pay benefits for
covered service , en `' ad and are then
due:
(1) monthly, when to `xpected to result in
ongoing benefits; or
(2) iT-&aiiately, when/ bility has ended.
k
'paid to You in
fin► You may request in writing for
to be a to someone other than You. You
ake this request no later than the time Proof
is filed. We will assume no liability for an
nt of benefits.
Ants unpaid at Your death will be paid to Your
state. f benefits are payable to Your estate, or if You
are of competent to give a valid release, We may pay
to $1,000 to any relative of Yours, or any other
person who has cared for or looked after Your affairs
and who is deemed by Us to be justly entitled to the
benefits. We will be discharged to the extent of any
such payment made in good faith.
Our Claims Evaluation Process: We will work with the
claimant, his or her Licensed Health Care Practitioner,
and other caregivers to obtain information about the
state of the claimant's health and the degree to which
care covered by this Policy is needed. We will then
make an objective review of that information to
determine whether the claimant qualifies for benefits,
and, if so, the level of benefits for which he or she
qualifies.
We reserve the right, as part of the review, to do a
telephonic or face-to-face assessment or to require the
claimant to take a physical examination paid for by Us.
Similar assessments and examinations may be
required, at reasonable intervals, to determine the
claimant's eligibility for continued benefits, but not more
often than once every three months.
TOL 1-C 1001 C-1 OPTIONS
We may use an outside service to assist in evaluating
the claimant's condition. We will pay for any outside
services used to assist in the evaluation.
HOW TO APPEAL A CLAIM
Appeal Process: We evaluate a claim based on the
provisions of this Policy and the information given to
Us. If You do not agree with a claim decision, You
may ask for a review. Your request must be in writing
to Us and include the names, addresses and phone
numbers of any of the following providers who You
think We should contact to learn more about the
claimant's health and the care received: the Doctors
and other health care professionals who treated the
claimant and the facilities from which the care or
treatment was received. No special form is needed.
Your request should be sent to Our Administrative
Office within 3 years of the time of filing written Proof
of Loss. You may authorize someone else to act for
You under this review procedure.
Within 60 days after receiving Your request
necessary supporting documents, We will send
Your representative Our decision. Our decision
in writing with Our reasons stated clearly---"
make available all information directly lattq
denial.
Legal Actions: An Insured Perso cannot brin"al
action before 60 days after wri n Pro oss hlas
been given to Us, as requir b Is Policy. n
Insured Person cannot bring leg acts fter ars
from the time written Proof of Lo Is req ed to be
given.
We have the right to reco a o erpayment made
because of an error m e ss` g of a claim. Also,
We will recover by offset n ounts that have not
been previously recovered at the time We make
another benefit payment.
Subrogation: If an Insured Person sustains an Injury or
Sickness as a result of the act or omission of a third
party and receives covered care or services, We shall
provide benefits for such Injury or Sickness in
accordance with the terms of this Policy. Acceptance
of such benefits will constitute consent to the
provisions of this section.
In the event of any payments for benefits provided to
an Insured Person under this Policy, We shall be
subrogated, to the extent of such payments, to all
rights of recovery such Insured Person has against any
person or entity. The Insured Person shall execute and
deliver such instruments and papers as may be
required and do whatev r else is necessary to secure
such rights to Us. A unt returned to Us shall be
reduced by the prysus(ed7ersok
of legal fees and court
costs incurred by
We shall have )err orrYfu" s received by the
Insured Person up to a arm of benefits provided
to the Insured Person. give notice of that lien
to an p who ma' ve caused or contributed to
the All ds r eshall be deemed to be for
benefits id by s or for the account of the
nsur Per r ' ' Bless of the characterization of
fu ds. In event that the Insured Person
ec 1ve funds on which We have a lien, such funds
11 sfrall held in trust until paid over to Us.
We decide, We may be subrogated to the
Insu erson's rights to the extent of the benefits
ived under this Policy. This includes Our right to
br suit against a third party in the Insured Person's
n me. We or our designee, upon giving thirty days
written notice to the Insured Person, shall have the
right to bring suit and take such action as necessary in
the name of the Insured Person to recover the amount
of benefits paid under this Policy, if the Insured Person
or anyone acting on his or her behalf has not taken
action against such third party to obtain a judgment,
settlement, or other recovery. Any action taken without
the consent of the Insured Person shall be without
prejudice to such Insured Person.
The Insured Person must take such action, furnish
such information and assistance, and execute such
instruments as We may require to facilitate
enforcement of Our rights under this provision. The
Insured Person shall take no action prejudicing Our
rights and interests under this provision.
TOL 1-C 1001 C-2 OPTIONS
GENERAL EXCLUSIONS AND LIMITATIONS
This Policy will not pay benefits when an Insured
Person is eligible for confinement, treatment, services
or care:
(1) resultinn frnm ninnhnikm rinin nririirtinn nr
(2)
(3)
(4)
(5)
(6)
(7)
(8)
chemic<
medicatl
arising
attempt(
or
provides
required
payable
except
coinsur
program
no chat
insuranc
received
for whic
federal
or occul
that are
of Care;
that are
governin
rendere(
Immedis
(a) he
orga
sery
(b) the
treal
(c) he c
the
or h
The exclusi
Person's Immediate Family and confinement, treatment,
services or care received outside the United States or
Canada will not apply to the Alternative Payment
Benefit provision. Coverage will be provided in
accordance with the terms of this Policy for mental
conditions, including Alzheimer's disease, Parkinson's
disease and senile dementia.
TOL 1-GEL 1001 GEL-1 OPTIONS
GENERAL DEFINITIONS
This section informs You of some of the special words
and phrases used in this Policy. Other words and
phrases may be defined in other sections of the Policy.
Please see the Definition Information provision in the
General Benefit _____A!-_ LL_ ..��
of definitions in
Someone, other
and licensed to
within the scot
does not includ
an Insured Pei
normally reside
anyone who h
employee of, a
the Plan of Can
Any place wher
a Nursing Homi
or other acute (
An Insured Pi
related to an
(including adol
parent, grandp<
aunt, uncle, firs
Any accidental
after the Effecti,
Anyone who is
on the Schedule page
Insured.
as the Policyholder or an
LAPSE
At the end of the Grace Period, if Your premium is not
paid, Your coverage will have terminated as of the last
Premium Due Date, subject to the Third Party
Notification provision.
LICENSED HEALTH CARE PRACTITIONER
Any Doctor, registered professional nurse, licensed
social worker, or other individual who meets such
requirements as may be prescribed by the Secretary of
the Treasury.
ct," Title XVIII of
1965 as then
�r:
or
1).
son's Immediate
in an Insured
provided by a
Initial Premium,
olicy.
)E
edule, with which
rvL.1%. r
This contract between You and Us.
SICKNESS
An illness or disease, as determined by a Doctor.
A legal spouse.
SPOUSE
GD-1 OPTIONS
YOU, YOUR, YOURS
The Policyholder named in the Schedule.
TOL 1-GD 1001
NURSING HOME
A facility, or that part of a facility, which:
(1) is licensed by the state in which it is located as a
nursing home or an Alzheimer's disease facility;
and
(2) is engaged in providing, in addition to room and
board accommodations, 24-hour Nursing Services
7 days a week by an on -site Registered Nurse
and related services on a continuing inpatient
basis; and
(3) has a planned program of policies and procedures
developed with the advice of, and periodically
reviewed by, at least one Doctor; and
(4) maintains a clinical record of each patient.
A Nursing Home may be either a freestanding fac"
or a distinct part of a facility such as a ward, ng,
unit, or swing bed of a hospital or other instltu
the facility complex to which an Insured erso ' is
confined consists of wards, wings, floor un
swing -beds, the area of the facility i whi
Insured Person is confined must be lice
Nursing Home and the Insured Person's assign tie,
must be included as a part of sucy'rceme,`
The term "Nursing Home" d s o clude, or
example: (1) a hospital (except as rove d o ; (2)
a rehabilitation hospital, 3 a place whichs primarily
for treatment of men or"' ervous d s (except
Alzheimer's disease d , or oholism; (4)
a home for the ag ; ( rest home, community living
center, or a plac that p` Ide d` mestic, resident,
retirement or educa a ; ) assisted living
facilities; (7) personal car 'hom ", (8) residential care
facilities; (9) adult foster care facilities; (10) congregate
care facilities; (11) family and group assisted living
facilities; (12) personal care boarding homes; (13)
domiciliary care homes; (14) basic care facilities; or
(15) similar facilities.
TOL 1-NHD 1001
ASSISTED LIVING FACILITY
A facility which is licensed, certified, or registered by
the appropriate authority in the state- in which it is
located and which charges a, fee to provide inpatient
care for persons who are not in need of the level of
care provided in a hospital or Nursing Home but who
are in need of assis _ ith Activities of Daily Living
or are Cognitively I h facility:
(1) provides Mal n r ce er al Care Services
by on -site f 3 a day, including
special diets,
(2) has procedures : ` ablishing appropriate
r , s__
protocol for medics anagement and the
h g and adi nlstration of drugs and
prove ncy call system and on -site
to respond to and meet both
uled a npredictable needs of residents on
-hour-a-day basis, including supervision of
ty and security, and who are aware of the
w abouts of the residents at all times; and
has central dining room, living room or parlor,
a, _common activity areas; and
has a Registered Nurse on -site .or on contract to
provide Nursing Services specified in the Plan of
Care.
Regardless of name, any properly licensed, certified, or
registered facility providing the services shown. above
will qualify as an Assisted Living Facility. As an
example, this could include adult foster care facilities,
congregate care facilities, basic care facilities,
residential care facilities, family and 'group assisted
living facilities, personal care boarding homes,
domiciliary care homes and personal care homes.
An Assisted Living Facility is not a nursing home,
hospital, or rehabilitation hospital, although it may be a
separate and distinct wing or section of such an
institution, if such wing or section, including an Insured
Person's assigned bed, is appropriately licensed,
certified, or registered to provide the level of care
defined above. An Assisted Living Facility is also not
an independent living apartment.
TOL 1-ALFD 1001
GD-2 OPTIONS
MAINTENANCE OR PERSONAL CARE SERVICES
Any care the primary purpose of which is to provide
needed assistance with any of the disabilities that
cause an Insured Person to meet the requirements of
the Benefit Eligibility provision (including the protection
from threats to health and safety due to Cognitive
Impairment.)
TOL 1-MPCD 1001
HOME HEALTH CARE
Services provided for care in an Insured Person's
Home and while such Insured Person is not confined
to any hospital or Nursing Home.
Professional Services are services that are beyond the
scope of care that can be provided by a Basic
Services provider. The services are for other than
monitoring the patient or supervising the patient's care.
Professional Services must be provided by a licensed
(1) Registered Nurse (RN); Practical Nurse (LP ;
Vocational Nurse (LVN); or
(2) speech therapist or audiologist; or
(3) respiratory therapist; or
(4) occupational therapist; or
(5) physical therapist; or
(6) chemotherapy specialist; or
(7) nutritional specialist ! _
Basic Services are services
than those included in the
Services.
Basic Services are
(1) a home health
(2) a homemaker;
(3) a companion.
TOL 1-HCD 1001
HOME HEALTH CARE AGENCY
An entity that provides care and services in accordance
with a Plan of Care in an Insured Person's Home; is
primarily engaged in providing Home Health Care
services; and
(1) is licensed by state law or certified by Medicare as
a Home Health Care Agency; or
(2) is accredited as a Home Health Care Agency or as
a provider of Home Health Care services by the
National League of Nursing, or the Joint
Commission on Accreditation of Healthcare
Organizations, or any other associations that have
substantially the same accreditation standards; or
(3) an entity that is t state licensed or Medicare
certified, provide entity:
(a) is a format ed ge hat has been organized
to provi H e under a Plan of
Care, ich is,_Su_ "rvi /or monitored at
least eve da y on -staff Registered
Nurse or licen soci orker; and
(b) hich maintains ritten record for each
di t, includi cumentation of all services
= delive a a an of Care.
ADULT DAY CARE
v. es, including health, social and related support
vices rovided by and at an Adult Day Care Center
itag y part of the day, on less than a 24-hour
1-ADCD 1001
ADULT DAY CARE CENTER
A facility or organization which is licensed, registered or
certified to provide Adult Day Care, if the state in
which it is located provides licensing, registration or
certification of Adult Day Care Centers.
If licensing, registration, or certification is not required
by the state, it is that part (or separate center) of a
facility which provides Adult Day Care and meets all of
the following requirements:
(1) it operates at least 5 days a week for a minimum
of 5 hours per day and is not an overnight facility;
and
(2) it maintains a written record for each client, which
includes a Plan of Care and a record of all
services provided; and
(3) it has established procedures for obtaining
appropriate aid in the event of a medical
emergency; and
(4) it has formal arrangements for providing for the
services of: (a) a dietitian; (b) a licensed physical
therapist; (c) a licensed speech therapist; and (d) a
licensed occupational therapist; and
GD-3 OPTIONS
CHECKLIST OF ITEMS INCLUDED WITH PROPOSAL
Yes No Description of Item
✓
Proposal for Group Life Insurance, AD&D and Supplemental Life
t✓
Proposal for Group Voluntary Life
Proposal for Voluntary Group Life and AD&D
i✓
Proposal for Group Long Term Disability
✓
Proposal for Group Dental
Proposal for Vision Care
✓�
Proposal for Transplant Coverage
Proposal for Long Term Care
✓
Signed Proposal Compliance Letter
Signed Plan Design Confirmation
Completed and Signed Questionnaire(s)
Dental Network Access Analysis (if applicable)
Vision Network Access Analysis (if applicable)
Copy of your EOB for Dental and/or Vision,Services (if applicable)
Proposed Implementation Timeline for The City.
Audited Financial Statements and/or Department of Insurance
filings for the past two years (Only if requested by The City)
Provider "Report Cards" used to provide feedback on clinical and
non -clinical performance measures
Copy of your Policy Assuring Member Satisfaction
Samples of all Standard and Optional Reports you are proposing
to provide on an account specific basis
Copy of your Banking Services Agreement
Copy of your Customer Satisfaction Survey
Copy of your Insurance
Contract that will be in effect January 1, 2004
City of Fort Collins, RFP 2003
(5) its staff includes all of the following: (a) a full-time
director; (b) one or more nurses in attendance
during operating hours for at least 4 hours a day;
and (c) not less than 3 full-time staff members.
TOL 1-ADCCD 1001
GD-4 OPTIONS
Note: Coverage is provided in accordance with the
ELIGIBILITY DEFINITIONS
terms of this Policy for Alzheimer's disease and similar
forms of senility and irreversible dementia that result in
ACTIVITIES OF DAILY LIVING (ADLS)
Cognitive Impairment.
Each of the following six (6) functional areas performed
without the assistance of another person is considered
an Activity of Daily Living:
PLAN OF CARE
A written, face-to-fac-___ stematic, standardized, and
(1) Bathing: The ability to wash oneself by
comprehensive as n = of one's functional and
sponge bath; or in either a tub or
cognitive capacity tl d eeds, strengths, and
shower, including the task of getting
abilities, sped ' g. ' u _ ion . uency, type and
into and out of the tub or shower.
scope of service f car- . The Plan of Care
(2) Continence: The ability to maintain control of
must be based c in " from the Insured
bowel and bladder function; or, when
Person's comprehensive s ent. The Plan of Care
unable to maintain control of bowel or
must prescribed, app' ed, and signed by a
bladder function, the ability to perform
Lice sed alth C ractitioner, and must be
in
associated personal hygiene
confer err at_ ast once each 60 days. The
(including caring for a catheter or
, and vicee u er the Plan of Care must be
colostomy bag).
requ` beca person is Cognitively Impaired or
/eVrabl to perfo m the Required Number of Activities
(3) Dressing: The ability to put on and take off all
f ai Living shown on the Schedule.
items of clothing and any necessary
braces, fasteners or artificial limbs
If pos ' e, a copy of the Plan of Care should be sent
(4) Eating: The ability to feed oneself by etting
to s re the care and services are received, or, at
food into the body from a rece c
the la st, at the time the first claim under the Plan of
(such as a plate, cup or or y _
is submitted. Unless otherwise stated in this
a feeding tube or intrav ous .
Icy, the Plan of Care must be submitted no later
(5) Toileting: The ability to get to a fro
than 60 days after the care and services begin and
toilet, to get on and off the t ' a
must document by assessment that the Insured Person
perform a ted pers al-
met the requirements in the Benefit Eligibility provision
h
hygiene.
during that 60-day period.
(6) Transferring: The ability to ve,' to nd out a
A Plan of Care must be approved by a Licensed
bed, chair or wh Icha' .
Health Care Practitioner who does not have a financial
interest in, or is not an employee of, the facility,
COGNITIVE IMPAAIM UNCWDl E TERM
agency, center or provider administering such plan.
Severe deterioratio or loss rson's intellectual
capacity as certifi .ce ed Health Care
Practitioner and diagnos usin generally accepted
medical diagnostic metho s and tests that reliably
measure impairment in the areas of:
(1) short or long term memory; and
(2) orientation as to person (such as who one is and
who others are), place (such as one's location)
and time (such as day, date and year); and
(3) deductive or abstract reasoning; and
(4) judgment as it relates to safety awareness.
TOL 1-ED 1001 ED-1 OPTIONS
BENEFIT ELIGIBILITY
This section describes the requirements that must
be met before any benefits provided under this
Policy can be paid.
ELIGIBILITY FOR T41F PAYMFNT nF RFNFFITS
To be eligible fc
Policy, We must
specifies what cai
needed because
certified within th
Health Care Practil
(1) requiring con
include cuein4
or other demc
protect the In:
or her healtl
Impairment; or
(2) requiring the I
arm's reach d
least the Requ
Living, shown
at least 90 d
present within
supervise of
intervention.
If an Insured Pei
requirements shoe
the requiremen
considered a Chn
requirement is ne
qualify for favon,
law.
TOL 1-BE 1001 BE-1 OPTIONS
GENERAL BENEFIT INFORMATION
In order for benefits to be payable, Benefit
Eligibility and all confinements, care and services
must begin after the Effective Date of this Policy
and while Your coverage is in force. All charges
must be incurred while the applicable Benefit
Section is in force, unless otherwise stated in the
applicable Benefit Section.
NOTE: If more than one type of covered care is
received on the same day, only the daily benefit
Providing the largest payment will be payable,
unless otherwise stated in a Benefit Section.
Limitations or Conditions on Eligibility for Benefits
The applicable Elimination Period, benefits and
benefit limits are shown on the Schedule. Below is
a description of the Elimination Period and some
benefit limits.
ELIMINATION PERIOD
If the Schedule and the Benefit Sections
an Elimination Period is applicable to the b
are payable, no such benefits will
expenses have been incurred for the nurr
shown on the Schedule. You will be
responsible for the expenses i
days. Senefrts subject to the expense;.
d
be paid during this elimination in on Pe
days have been accumulated to s n.
sfy is
Period, it need never be satisfied
Elimination Period an pn��"f �__gain'<
The Elimination P 'o
on which the exp nses in pe
covered under this
Period. An Insured Persy
confined or received care or
Elimination Period is required
satisfy an Elimination Period.
separate
)eere
satisfied by days
uld otherwise be
no Elimination
ually have been
services for which an
on any day used to
Days on which expenses that would also be eligible for
coverage under this Policy, except for the Elimination
Period, and are reimbursed by Medicare will also be
credited toward the Elimination Period.
Benefits subject to MAXIMUMBENEFIT
Maximum Benefit are listed on
the Schedule.
As shown on the Schedule, the Maximum Benefit
Payable for each Insured Person for all the benefits
listed on the Schedu
dollar amount oava �-
the total Maximum Benefit
When the Max
benefits for su
unless otherwise pro
of another provision of
I Paid, no further
Will be payable,
Je with the terms
D TIO INFORMATION
ial rds an, phrases are given defined
mean! s in ri s sections of this Policy, if a
of a Ord or phrase is found in any
t!o of this Policy, it shall have
meta'
Ing throughout the Polic the same
eco op Y To help You
g these special words and phrases, the
fi le r of each word, or word in the phrase, is
capita zed wherever it appears.
BENEFIT SECTIONS
The following sections describe the coverage
available for care and services covered under this
Policy. Read the benefit provisions carefully. Care
Coordination is not required to access benefits
under this policy unless otherwise specified in a
benefit section. Premiums for this Policy must be
paid when due in order for the coverage to remain
in force. Remember, the Schedule will only show
the benefits and benefit amounts You elected and
We initially issued. Any benefits You subsequently
add or delete and any increases or decreases You
request in benefit amounts, and their respective
effective dates, will be indicated by endorsement
and all Policy and benefit provisions, waiting
Periods and elimination periods will be calculated
addition.
from the effective date of such increase or
TOL 1-G81 1001
GBI-1
OPTIONS
NURSING HOME BENEFIT
We will pay the actual charges incurred for each day
an Insured Person is confined in a Nursing Home
subject to:
(1) the Benefit Eligibility provision;
(2) the Elimination Period;
(3) the Maximum Daily Benefit;
(4) the Maximum Benefit; and
(5) care and services must be provided in a facility
that is licensed by the state as a Nursing Home.
EXTENSION OF THE NURSING HOME BENEFIT
Subject to the Maximum Benefit, termination of this
Policy will not affect any claim for a covered Nursing
Home stay if such stay began while this Policy was in
force and continues without interruption after
termination of this Policy. We will not, however, pay
benefits for new Nursing Home confinements or for any
part of a confinement during which the reason for the
confinement becomes unrelated to the reason for e
confinement prior to the termination of the Policy _ e
will not pay the portion of the Nursing Home enefi
which is in excess of those benefits We would Oe
paid had this Policy continued in force. T ' i
will not apply to any other benefit in this , licy.
NURSING HOME BED RESERVATION BENE
When an Insured Person is a ebS^nt tbr-a reas
(except discharge) during a Nur ng H"con fine t,
the benefit will be one or a com` in Ion of the
following:
(1) if the absence occ r the limi ion Period
has been met, a w` the 'c I Nursing
Home charges c ' re or Too an board while
the room in th N ing e ` being reserved
during each da su d erson's absence,
up to the Maximum Da' Bene or
(2) if the absence oc hile satisfying the
Elimination Period and room and board charges are
incurred from the Nursing Home to hold the room,
We will give credit toward the Elimination Period for
each day the Insured Person is absent.
This benefit is available for the Maximum Number of
Days per Calendar Year shown on the Schedule and
subject to the Benefit Eligibility provision.
TOL 1-NH 1001
RESTORATION OF NURSING HOME BENEFITS
This provision only describes how benefits can be
restored. The requirements found in the Benefit
Eligibility provision, therefore, shall not apply to
this provision. This provision, however, is subject
to the requirements described below.
Following a Nursin ,_ -`e _ nfinement for which We
have been payin = Ho_ a Benefit, We will
restore such g oamounts to the
remaining apple i t- enefit if certain
requirements are meK �- ' es any increases to
the Maximum Benefit tha ave occurred under a
Benef' , rease Opt'if' elected. The amounts
appli to . Kestor ill only be applicable to the
Nursing _ r subsequent Nursing Home
y he sto amount will not exceed the
Bene able.
for Restoration of Nursing Home
r a -pliod of 180 consecutive days, the Insured
Per ust not meet the requirements found in the
nefit Eligibility provision for Cognitive Impairment and
Vtiv
nability to perform at least the Required Number of
ities of Daily Living shown on the Schedule page.
The 180 consecutive day period begins on the day a
Licensed Health Care Practitioner certifies that the
Insured Person does not meet the requirements for
Benefit Eligibility and such certification is filed with Us.
The Policy must remain in force during this time period.
TOL 1-NROB 402
ASSISTED LIVING FACILITY BENEFIT
We will pay the actual charges incurred for room and
board, not to exceed the charge for a one -bedroom
unit, and for the necessary Maintenance and Personal
Care Services for each day an Insured Person is
confined in an Assisted Living Facility subject to:
(1) the Benefit Eligibility provision;
(2) the Elimination Period;
(3) the Maximum Daily Benefit;
(4) the Maximum Benefit; and
(5) care and services must be provided while confined
in a licensed, certified, or registered Assisted Living
Facility.
OPTIONS
ASSISTED LIVING FACILITY BED RESERVATION
BENEFIT
When an Insured Person is absent for any reason
(except discharge) during an Assisted Living Facility
confinement, the benefit will be one or a combination
of the following:
(1) if the absence occurs after the Elimination Period
has been met, We will pay the actual Assisted
Living Facility charges incurred for room and board
while the room in the Assisted Living Facility is
being reserved during each day of the Insured
Person's absence, up to the Maximum Daily
Benefit; or
(2) if the absence occurs while satisfying the
Elimination Period and room and board charges are
incurred from the Assisted Living Facility to hold
the room, We will give credit toward the Elimination
Period for each day the Insured Person is absent.
as required by the state to provide such services
and is approved by the Care Coordinator.
For any day during which an Insured Person receives
both Professional and Basic Services, We will pay up
to the Maximum Daily Professional Services Benefit.
The Home Health nefit is not subject to, nor
will it satisfy, the EJ oryRgriod.
We will pay the a I cha?cfes ' curred for each day
an Insured Person rece s A Day Care, subject to:
(1) th enefit Eligibili _pro"` ion;
(2) a Ma um Da' It Day Care Benefit;
(3) th 71M
This benefit is available for the Maximum Number of v goidi
Days per Calendar Year shown on the Schedule d
subject to the Benefit Eligibility provision. Th
TOL 1-ALF 1001 atlsfy, i
HOME HEALTH CARE AND ADULT f Y C
BENEFITS
Neither Home Health Care nor Adult Da - Ca
benefits will be payable on any tan Ins d
Person is confined as an in tien in a ho or
Nursing Home. However, su b n may be
payable on a day that the sur P rs n is
admitted for confinr dis arge following
such confinement. erso
HOME EALTH BE EFIT
We will pay the ac a Inc rred for each day
an Insured Person receive Hom ealth Care, subject
to:
(1) the Benefit Eligibility provision;
(2) the Maximum Daily Professional Services Benefit or
Maximum Daily Basic Services Benefit;
(3) the Maximum Benefit; and
(4) Basic Services must be provided by or through a
Home Health Care Agency, unless the Insured
Person is receiving the Care Coordination Benefit.
If the Insured Person is receiving the Care
Coordination Benefit, Basic Services may be
provided by a provider who is licensed or certified
or sere s must be provided by and at
alt "re Center; and
Day Care must be received for at least 4
during any day for which benefits are
Day Care Benefit is not subject to, nor will it
Elimination Period.
1-HHAD 1001
HOSPICE CARE BENEFIT
DEFINITIONS
HOSPICE CARE
A coordinated, interdisciplinary program for meeting the
special physical, emotional, social and spiritual needs
of dying individuals, by providing palliative and
supportive services during the illness to individuals who
have no reasonable prospect of cure and, as estimated
by a Doctor, have a life expectancy of 6 months or
less.
HOSPICE CARE FACILITY
A facility which is licensed or certified by the state in
which it is located to provide Hospice Care.
HOSPICE CARE PROVIDER
Any hospital, related institution, Home Health Care
Agency, Hospice Care Facility or other licensed
provider which provides Hospice Care.
OPTIONS
HOSPICE CARE BENEFIT
We will pay the actual charges incurred for each day
an Insured Person receives Hospice Care subject to:
(1) the Benefit Eligibility provision;
(2) the Insured Person must have no reasonable
prospect of cure and, as estimated by his or her
Doctor, have a fife expectancy of 6 months or less;
(3) the Maximum Daily Benefit;
(4) the Maximum Benefit; and
(5) Hospice Care must be provided by a Hospice Care
Provider.
Benefits for Hospice Care are not subject to, nor will
they satisfy, the Elimination Period. We will not pay for
more than 180 days of Hospice Care.
TOL 1-HC 1001
CARE COORDINATION BENEFIT
DEFINITIONS
CARE COORDINATION
The development of a comprehensive,
fa e-to-
assessment of a person's functional an
co
capacity. A Care Coordinator will =
coo ' `ate
appropriate services and monitor the deli v
of
services including:
(1) development, completion, i
tation
coordination of the Plan of e;
(2) monitoring of services provi u he Pla of
Care;
(3) completion of a comprehensive eas
ssment of
the Plan of Care, nee ed; and
(4) discharge from a en n
he Plan of
Care, when ap rop
A person contracted by wh a Licensed Health
Care Practitioner and provides Care Coordination
services.
"Care Coordinator" will not include anyone who has an
ownership interest in or is an employee of any provider
of the care or services received.
CARE COORDINATION BENEFIT
In order to obtain a Care Coordinator, an Insured
Person must contact Us at the toll -free number shown
on the Schedule and select a Care Coordinator
contracted by Us from Our list. The Care Coordinator
will objectively review the Insured Person's care needs,
address concerns he or she may have and provide
advocacy for him or her and the family. While working
with the Insured Person, the family, and Doctor, the
Care Coordinator will help to establish an individualized
Plan of Care. Upon the Insured Person's request, the
Care Coordinator will - ' e him or her with a list of
care providers and -` s . his or her area for the
Insured Person o -r. either the Care
Coordinator n _ gsu or recommend
providers or guar care by any of the
providers or service ftsta_1 ' ever, it will be a
starting point for the - `' Person to use when
seekin re directly f m ese providers. The Care
Coor II mai -= n ongoing relationship with
the Ins 3 e family, monitor the Insured
s p ` working with his or her Doctor,
modify a Pla f, re to adapt to changing needs.
"won n to other benefits paid under this Policy, We
wig, ` for the Care Coordinator to initially assess and
eveloP _ Plan of Care. Thereafter, We will pay for the
Ca ' Co dination services of the Care Coordinator for
yIn as the Insured Person meets or is expected to
the requirements in the Benefit Eligibility provision
he or she is receiving or is expected to receive
other benefits payable under this Policy. If the Care
Coordinator determines it is necessary, and if the
Insured Person desires, the Care Coordinator will assist
the Insured Person in obtaining the services
recommended in the Plan of Care. This assistance will
be limited to referring the Insured Person to providers
and help in coordinating such referrals. There will be
no charge to You for the covered Care Coordination
services of the Care Coordinator and no amount will be
deducted for such covered Care Coordination services
from the maximum benefits payable under the Policy.
The Care Coordination Benefit includes the services of
the Care Coordinator to arrange for services to assist
the Insured Person in remaining at Home, such as:
(1) home health care services;
(2) durable medical equipment and supplies;
(3) emergency medical call system;
(4) companion services;
(5) shopping services; and
OPTIONS
(6) transportation services.
The benefits for the covered Care Coordination
services provided by the Care Coordinator are not
subject to, nor will they satisfy, the Elimination Period.
TOL 1-CC13 1001
RESPITE CARE BENEFIT
If an Insured Person is receiving the Care
Coordination Benefit, this additional benefit is
available.
DEFINITION
Care Coordinator must approve the provider of the
Therapeutic Device.
DEFINITION
THERAPEUTIC DEVICE
Special equipment tha is appropriate for an Insured
Person's condition a at his or her Home. The
following are exam - of equipment that may
be considered T ut ` Ice
(1) special ho s;
(2) crutches;
(3) wheelchairs;
(4) inf Ion pumps; or
(5) ro�s. /\
RESPITE CARE
Respite or relief for an Insured Person's primary
A Ther utic v` does not include any drug,
caregiver. Respite Care covers temporary confinements
reed ' e, equt ` ent implanted in an Insured
in a Nursing Home, Assisted Living Facility, or care
PIT ' body, porarily or permanently. Also, not
received in an Insured Person's Home.
ncl d is any Home modification, motorized scooter,
o s ing, protective, athletic or exercise equipment.
RESPITE CARE BENEFIT
If an Insured Person is being cared for by his r h
THERAPEUTIC DEVICE BENEFIT
primary caregiver on a continuous basis and uc
a wi I pay the actual charges incurred for rental or
caregiver is not compensated by You for is
pur hase of a Therapeutic Device subject to:
services, We will pay the actual charg i ` o
the Insured Person receiving the Care Coordination
Respite Care, subject to:
Benefit;
(1) the Benefit Eligibility provision;
(2) the Benefit Eligibility provision;
(2) the Respite Care Maximum D ' efit;
(3) the Maximum Lifetime Therapeutic Device Benefit;
(3) the Respite Care Maximu Number o e
(4) the Maximum Benefit; and
Calendar Year;
(5) the equipment must be used in the Insured
(4) the Maximum Benefit; and
Person's Home.
(5) Respite Care must be rovided a N ing Home,
Assisted Living F Ity, r in the nsur Person's
We will decide whether a rental or purchase of the
Home
Therapeutic Device would be more appropriate.
Benefits for Respi Care n t s bject to, nor will
For purposes of the Therapeutic Device definition and
they satisfy, the Elim d,
the Therapeutic Device Benefit, an Insured Person's
Home shall not include an Assisted Living Facility.
Benefits for Respite Care not be payable when
other benefits, except for Care Coordination, are
The Therapeutic Device Benefit is not subject to, nor
payable under this Policy.
will it satisfy, the Elimination Period.
TOL 1-RC 1001 TOL 1-TDB 1001
THERAPEUTIC DEVICE BENEFIT
If an Insured Person is receiving the Care
Coordination Benefit, this additional benefit is
available. To qualify for this additional benefit, the
HOME MODIFICATION BENEFIT
If an Insured Person is receiving the Care
Coordination Benefit, this additional benefit is
available. To qualify for this additional benefit, the
Care Coordinator must approve the provider, labor,
equipment and supplies. Prior to any modification
OPTIONS
or installation, We must agree to the modification
or installation.
HOME MODIFICATION BENEFIT
We will pay the actual charges incurred for labor,
equipment, and supplies for minor modifications to an
Insured Person's Home that will enhance his or her
ability to perform the Activities of Daily Living and allow
the Insured Person to remain in his or her Home
safely, subject to:
(1) the Insured Person receiving the Care Coordination
Benefit;
(2) the Benefit Eligibility provision;
(3) the Maximum Lifetime Home Modification Benefit;
and
(4) the Maximum Benefit.
Examples of Home modification include such things as:
installing a ramp in an Insured Person's Home or
installing grab bars in an Insured Person's bathroom
and similar accessibility modifications. 1-1
Home modification does not include things
home repair, cosmetic changes, elevators,
rooms, remodeling, installation of a h
swimming pool, or any similar modificatio VI
pay for the purchase of any tools. Also,
pay for the removal or reversal of ar
modification that was previously
benefit.
For purposes of the Home Mo ificatipn/Be fi an
Insured Person's Home shall not ud a Assisted
Living Facility. /---
The Home Modific0lo it is t s'v6ject to, nor
will it satisfy, the E in rt P '
TOL 1-HMB 1001
MEDICAL ALERT SYSTEM BENEFIT
If an Insured Person is receiving the Care
Coordination Benefit, this additional benefit is
available. To qualify for this additional benefit, the
Care Coordinator must approve the provider. Prior
to any modification or installation, We must agree
to the modification or installation.
DEFINITION
MEDICAL ALERT SYSTEM
A communication system installed in an Insured
Person's Home that is used solelyfor the purpose of
calling for assistance in the event of a medical
emergency.
We will pay for __: _ _ w- rf either:
(1) the actual mo _ monitoring charges
incurred up to t edical Alert System
Benefit; or
(2) th aI purchas9Ispst.
We wil 9R, �=Would
rental or a purchase of the
la►l aI, Ale = ysi be more appropriate.
Alert System Benefit is subject to:
ed Person receiving the Care Coordination
the _ efit Eligibility provision;
(3) aximum Medical Alert System Benefit; and
W the Maximum Benefit.
09 will not pay for any charges for normal telephone
service, or for a home security system, or any other
similar service or device.
For purposes of the Medical Alert System definition and
the Medical Alert System Benefit, an Insured Person's
Home shall not include an Assisted Living Facility.
The Medical Alert System Benefit is not subject to, nor
will it satisfy, the Elimination Period.
TOL 1-MAS13 1001
CAREGIVER TRAINING BENEFIT
If an Insured Person is receiving the Care
Coordination Benefit, this additional benefit is
available. To qualify for this additional benefit, the
Care Coordinator must approve the provider of the
training.
DEFINITIONS
CAREGIVER TRAINING
Appropriate training and instruction provided by a
person approved by the Care Coordinator to provide
the knowledge and skills necessary for:
OPTIONS
(1) the proper use and care of a therapeutic device
and/or disposable medical aids, including but not
limited to catheters; ostomy bags; or suctioning
tubes; or
(2) the performance of appropriate caregiving
procedures, such as changing of wound dressings,
repositioning a patient in bed, or giving insulin
injections.
VOLUNTEER CAREGIVER
The person who has the primary responsibility of caring
for an Insured Person in his or her Home. A person
who is paid for caring for an Insured Person cannot be
a Volunteer Caregiver.
CAREGIVER TRAINING BENEFIT
We will pay the actual charges incurred for Caregiver
Training for an Insured Person or a Volunteer
Caregiver to assist an Insured Person, subject to:
(1) the Insured Person receiving the Care Coordination
Benefit;
(2) the Benefit Eligibility provision;
(3) the Maximum Lifetime Caregiver Training Be fit
(4) the Maximum Benefit; and
(5) the Caregiver Training must not r e
included free of charge by an equipm nt supp
vendor.
The Caregiver Training Benefit is t subject to
will it satisfy, the Elimination Per'
TOL 1-CTB 1001�
MONTHLY ME ARE B EFI
If an Insured P rs )addit
l the Care
Coordination Be efi is nal benefit is
available. To qua' for nal benefit, the
Care Coordinator m a provider of the
care or services.
MONTHLY HOME CARE BENEFIT
We will pay, in lieu of the Home Health Care Benefit
and Adult Day Care Benefit, the actual charges
incurred for Home Health Care and Adult Day Care on
the basis of the services received during each
continuous 30-day period rather than on a daily basis,
subject to:
(1) the Insured Person receiving the Care Coordination
Benefit;
(2) the Benefit Eligibility provision; and
(3) the Maximum Benefit.
The maximum benefit payable during each continuous
30-day period will be limited to an amount calculated
by multiplying the Maximum Daily Basic Services
Benefit shown on the Schedule by 30.
TOL 1-MHC 1001
ALTE T/ErPA' E ENEFIT
Once an Insur Person s b rtified to meet the
requirements foun t-her. ligibility provision for
Cognitive Impairment o e n 'dity to perform at least
the R ired Number of vities of Daily Living as
sho on Sched d We have received a Plan
of Ca W y Y u the Monthly Benefit shown
e S " ufe n ance for each calendar month
the I ure er n continues to meet those
alire " nts. We will pay this benefit in lieu of all
l r ` nefits for care or services provided under this
Polic .
I n I ured Person meets the Benefit Eligibility
equir ents and We receive a Plan of Care for only
p of a calendar month, We will prorate the Monthly
efit payment. We will not pay this Benefit for any
time period prior to the time We receive the Plan of
Care. We must receive a Plan of Care at least once
each 60 days.
This benefit is also subject to the Maximum Benefit.
We will not pay this benefit when an Insured Person is
confined in a hospital or rehabilitation hospital.
We will stop paying this benefit to You on the day that
the Insured Person no longer meets the requirements
in the Benefit Eligibility provision. We will also stop
paying this benefit if We do not receive a Plan of Care
as required or when an Insured Person chooses to
receive other benefits payable for care and services
that are covered under this Policy.
The Alternative Payment Benefit is not subject to, nor
will it satisfy, the Elimination Period.
TOL 1-APB 1001
FULL RESTORATION OF BENEFITS
This provision only describes how benefits can be
restored. The requirements found in the Benefit
Eligibility provision, therefore, shall not apply to
OPTIONS
Mr. James B. O'Neill II, CPPO, FNIGP
The City of Fort Collins
Purchasing Department
215 North Mason St, 2nd Floor
Reference RFP P902
PO Box 580
Fort Collins, CO 80522
Dear Mr. O'Neill,
Please consider this my confirmation that the benefits offered in this proposal are the same
benefits currently being offered by Transamerica through the City of Fort Collins.
Sincerely,
Christi Johnson
Proffitt Benefit Services
5250 E Arapahoe Rd
F7-209
Centennial, CO 80122
1-866-796-9471
this provision. This provision, however, is subject
to the requirements described below.
Following a period during which We have been paying
benefits, We will restore such benefit amounts that We
paid to the remaining Maximum Benefit, if the Insured
Person meets certain requirements. This includes any
increases to the Maximum Benefit that may have
occurred under a Benefit Increase Option, if elected.
The amounts applied to the restoration will only be
available for subsequent stays or care subject to the
restored Maximum Benefit. The restored amount will
not exceed the Maximum Benefit payable.
Requirements for Full Restoration of Benefits
For a period of 180 consecutive days, the Insured
Person must not meet the requirements found in the
Benefit Eligibility provision for Cognitive Impairment and
the inability to perform at least the Required Number of
Activities of Daily Living shown on the Schedule page.
The 180 consecutive day period begins on the day a
Licensed Health Care Practitioner certifies that
Insured Person does not meet the requirement .for:
Benefit Eligibility and such certification is filed w'
The Policy must remain in force during this time pe
TOL 1-FROB 402
WAIVER OF PREMIUM BENEFIT
We will automatically change Y ur m Pay
Mode to monthly and not requi ayment o r
monthly premium when an Insur Pe on qu if�e`"' for
the Waiver of Premium Benefit.
To qualify for the iverf Premi nefit, the
Insured Person mus .
(1) meet the req ire is the -Benefit Eligibility
provision;
(2) satisfy the Elimina ion applicable; and
(3) be receiving Nursi e, Assisted Living
Facility, Home Health Care, Adult Day Care, or
Alternative Payment Benefits.
We will stop waiving the premium when the Insured
Person no longer qualifies for the Waiver of Premium
Benefit. The Waiver of Premium Benefit will end on the
date the Maximum Benefit has been exhausted.
To keep Your Policy in force when the Waiver of
Premium Benefit ends or after an Insured Person no
longer qualifies for the Waiver of Premium Benefit,
premiums must be paid as they become due. Any
unearned premiums on deposit with the Company at
the time the Waiver of Premium period began will be
applied following the = of the Waiver of Premium
period.
TOL 1-WP13 1001
JOINT WAWREMIUM
We wil waive all premiu or Your Policy for the
same_ no s that W waiving the premiums for
Your _ of -: i er the Waiver of Premium
B fit. uin s d=y aiving the premiums for Your
oficjf rider isA vision when We are no longer
yvanting _ e premi s for Your Spouse's policy.
ity for Joint Waiver of Premium: This benefit
I[y; _ ailable if:
both" ou and Your Spouse have coverage in
e
with Us as a married couple on the same
policy form series which includes this Joint Waiver
of Premium Benefit; and
Your Spouse qualifies for and receives the Waiver
of Premium Benefit under the same policy form
series.
This Joint Waiver of Premium Benefit ends when the
Maximum Benefit has been exhausted under either
Your Policy or Your Spouse's policy. To keep Your
Policy in force when Your Joint Waiver of Premium
Benefit ends or We are no longer waiving the premium,
premiums must be paid as they become due. Any
unearned premiums on deposit with the Company for
Your Policy at the time the Waiver of Premium period
began will be applied following the end of the Waiver
of Premium period.
Premiums will not be waived under this provision if
premiums are being waived for Your Spouse under a
Lifetime Waiver of Premium provision.
TOL 1-JWP 1001
LIFETIME WAIVER OF PREMIUM
After an Insured Person has been continuously
confined in a Nursing Home for the Consecutive Day
Waiting Period shown on the Schedule, We will not
OPTIONS
require payment of any future premium that would
otherwise come due for benefits in force on the date
such waiver begins. During the entire Consecutive Day
Waiting Period, the Insured Person must have been
confined in a Nursing Home or hospital and have been
satisfying the Elimination Period or receiving the
Nursing Home Benefit. However, the days during which
the Insured Person is confined in a hospital will not be
credited toward satisfying the Consecutive Day Waiting
Period. We will refund the unearned portion of any
premium You have paid.
The premium for any benefit added after the Lifetime
Waiver of Premium Benefit begins will not be waived
under this provision.
The Lifetime Waiver of Premium Benefit will end on the
date the Maximum Benefit has been exhausted.
TOL 1-LWP 1001
SPOUSE SURVIVORSHIP — WAIVER OF PREMIU
If You and Your Spouse both have coverage in orc
with Us under this policy form series and Your u9
dies while both policies are in force, We ill w
Your premiums for life following the later o .
(1) the date of death of Your Spouse;
V) the tenth anniversary of the Effective �ofl`a>�
Policy.
Any benefit added or increased usS
e t
least 10 years from the date ofincreas or
addition before the premium will fo such
benefit.
The premium for
Your Spouse will
You must notify U
TOL 1-SSWP 1001
K,& death of
its provision.
Spouse.
SIMPLE BENEFIT INCREASE OPTION
If You elected the Simple Benefit Increase Option,
every dollar benefit amount will increase annually on
each anniversary of the effective date of this option.
Each increase will be equal to the percentage shown
on the Schedule or endorsement of the original dollar
benefit amounts in effect on the effective date of this
option (without regard to any claims paid). These
increases will continue as long as this option is in
force, even if an Insured Person is receiving benefits
on the date of the increase.
Any benefit amounts You add in order to increase the
amount of Your coverage after the effective date of this
option will not increase until the amount of the increase
has been in effect one fMll year.
TOL 1-SBI0 1001
COMPO D BENEI It R E OPTION
If You elected the ornpou B efit Increase Option,
every dollar benefit a unt w' increase annually on
each iversary of the a tive date of this option.
Eac inc: re a will b al to the percentage shown
on th Sched o en rsement of the current dollar
It a nts m ef, t (without regard to any claims
paid). Thes 'ncr ases will continue up to the
Imu Multiply shown on the Schedule of the
Ina dollar benefit amounts as long as this option is
in fo e, even if an Insured Person is receiving benefits
lZn the to of the increase.
ny kflefit amounts You add in order to increase the
a unt of Your coverage after the effective date of this
ion will not increase until the amount of the increase
has been in effect one full year.
TOL 1-CBIO 1001
STEP -RATED COMPOUND BENEFIT INCREASE
OPTION
If You elected the Step -Rated Compound Benefit
Increase Option as shown on the Schedule or by
endorsement, in consideration of future increases in
premium amounts, every dollar benefit amount will
increase annually on each anniversary of the effective
date of this option. Each increase will be equal to the
Benefit Increase Percentage shown on the Schedule of
the current dollar benefit amounts in effect (without
regard to any claims paid). These increases will
continue as long as this option is in force, even if
benefits are being received on the date of the increase.
Your current premium will be increased by the
Premium Increase Percentage shown on the Schedule.
The increase in premium will occur at the Premium
Increase Frequency shown on the Schedule, as long
as this option is in force.
OPTIONS
to all of the
I insurancewe will be SU eve date of
(6) the add1wI the Policy, from
to terminate r415ions °f and remium is being
no u5 in )NOW9e option. the increase', becomes paid -up or p
will
can a �° additional increa�
anY t►me, Y°u Benefit Increase insulting �7) ;{ Goverag death, - Premium
Rated Compound amounts a due to a remium Cha n the date of
Step- benefit next anniversary of waived a
in dollar a date We only be available at ra * in eff Bach- Insured
e increases s will stop on will be at Our table _ based on
increase Option following to bon Your date of Purr
emium date of this P mate this P purchase, and
nt
A entiv, a not►ce to terra and premium amount
attain
eceive Your Duals fined level. Your person s -
dollar benefit n current
atta►ned th to Our right t0 increase 10p1 , - r
wal remain at the ?OL 1 GPO ;
��, BENEFIT fit
remain 5ublect tbens
premiums RETURN 0 to
a contrary, Eve Date,
premiums any provisw rce from its EF8 Sons have
100 Sublet lanuousl Insured policy
1 should
10L 1SRB10 TION has er all
OP 85 to this benefit if the �y5 of the
pURGHA$E a be 90
GUA k%TEED reach age the a urs within
lion, until You the a Bath as due.
You have the insurance °n ant w of all
amounts of every Three Yea's -Y a emium paym
additional ich wil Date a ' ast Pr sum less
Purchase on pates of the EffectNe benefit will be the sums)
Purchase Dpathe third annrrers'ing conditwns: of this waived pram the terms
to the fa r The _ m0U paid (excluding anY ursuanl to
Beginning on { of insurabiRy; hnefds Paid P of tht5 benefit uP
of this poUcY, subj wire any evidence the Purchase t of any Effective Date
�1} We will not reA force on the from the ris death,
Must be ►n
�2) this Policy the last Insured Pe to
Us of the Purchase Pn da a of the 1 I me in one lump sums
option Dates; not more to as Show in
(3) upon noffic�tion by Us in writing D of benefits wig will be If there
must natrfy Purchase w . Payment Your beneficiary by You•
Date, Y°u fore or after the -_ iarl later Chang date of Your
days be additional Your bane
31 wish to purchase rf You do n Your applicat'O" �Nin9 beneficiary Yourhestate .
if You. not is no named to
and
You are under nod 10 if You do the benefila will be paid Vving
this Pe Purchase er t death, at all time by 9 the
within anY On beneficiary date of
anal insurance on is a Your is
add` fit terming 5.w+ ►in Chang us, She effective the change
this bane do no "no nal You may date
Dates, 7� if You tc notice
will be pelf You die before We
not 0 Rate, written U5, effect age of aye ►on five.
period or if You d0 Tar Pur beneficiary teCorded by ill not be
on a portico n be receivedd Ter the change w
I ina ran t 16°!° recelve
this benefit termin a 'on ate is
(4) the amount af P chase Amounts greater 10L 1-R0P 1001 EFIT
sed pREM1UM ben
ofr amoun t m / Y= ' urchaepuaddi9o�l RETURN OF contrary, if this Date
Of less You FULI. the Effective
u an endorsement to to anY provision to from its
than rovision• dollar Subject in force persons hoo
under this We will av
se all of the been continuouad after all Insured policy shoo
increa regard to any claims a benefd will be P efit if the 90 days of t
insurance, which a this ben
Your Policy is without We will also pay occurs within
benefit amoun will be at di�ep$e and the last death due,
i insuran h date of pre
Payment was
paid); for the additiona last p
remium in effect on h Insured date the
(5) d On
ou table and rates Will On
bhe dal of Purchase*'
person 5' a,V,,ed 9
09-f 10l
The amount of this benefit will be the sum of all
premiums paid (excluding any waived premiums) for
the Policy, from the Effective Date of this benefit up to
the date of the last Insured Person's death.
Payment of benefits will be made in one lump sum to
Your beneficiary. Your beneficiary will be as shown in
Your application unless later changed by You. If there
is no named or living beneficiary on the date of Your
death, the benefits will be paid to Your estate.
You may change Your beneficiary at any time by giving
written notice to Us. The effective date of the
beneficiary change will be the date the change is
received and recorded by Us. If You die before We
receive the request, the change will not be effective.
If all benefits under this Policy have been exhausted
and it would otherwise terminate but an Insured Person
is still alive, We will continue to pay benefits under this
Policy up to the sum of all premiums paid for this
Policy (excluding any waived premiums).
No additional payment of premium will be r uir
Payment of benefits will be subject to all of the t
conditions and requirements of this Pol' . o d
death occur while any amount remains u aid We
then pay the beneficiary the remaining am nt.
TOL 1-FROP 1001
NONFORFEITURE BENEFIT — OK�Efd D BEN T
PERIOD �/
After Your coverage has been in a ect f at least 3
full years, this Bene pro des for a verage to
continue on a limit i Id erwise have
Lapsed for nonpay en premium.
The daily benefit ar�or�rrt'; bl will be the same
amounts available at the e t coverage under this
Policy would have Lapsed. a total benefit amount in
force under this Benefit will be equal to all of the
premium paid, excluding waived premiums, for all
coverage combined, including this Benefit.
The minimum benefit provided under this Benefit will be
equal to 30 times the Nursing Home Maximum Daily
Benefit at the time of Lapse. Combined benefits under
Your Policy and this Benefit will not exceed the
maximum amount payable for each benefit nor the total
benefits that would have been payable under Your
Policy if it had remain in premium paying status. All
of the eligibility requ' —' its, including waiting periods,
elimination periods o1 ed " ' e amounts that applied
in order for a 1 r rso o be eligible for
payment of be is ti Y `r coverage would
have Lapsed will E ent that any such
eligibility requirement or aiting periods were
satisfie under Your cover at the time it would have
Laps d will alsoAsatisfied under this Shortened
V=
If, at a time Your coverage would have Lapsed, You
haye a nefit in force that would allow coverage to
beco paid -up or premium to be waived for life at
e tir11a Youcoverage would have Lapsed, a
fit ncrease ption benefit of any kind was in
e benefits will NOT continue to increase.
sbgie future date, this Benefit will only apply if
erage would have Lapsed before the date when
coverage would otherwise have become paid -up or the
waiver of premium would begin.
This Benefit will terminate on the date coverage
becomes paid -up or premium is waived under any such
provision.
If, at the time Your coverage would have Lapsed, a
return of premium benefit was in force, that benefit will
terminate as of the date Your coverage under the
Policy would have Lapsed due to nonpayment of
premium, and no return of premium benefit will be paid
under this coverage.
TOL 1-NFB 1001
RATE GUARANTEE
Premiums for this Policy are guaranteed from the
Policy's Effective Date for the period of time shown on
the Schedule.
TOL 1-RG 1001
OPTIONS
CONTINGENT NONFORFEITURE BENEFIT
After the expiration of the rate guarantee, if any, if We increase Your premium rates to a level which results in a
cumulative increase of the annual premium equal to or exceeding the percentage of Your Initial Premium set forth
below and You are unable to afford the increased premium, You may choose one of the two coverage options offered
in this provision. We will notify You at least 30 days prior to the due date of the premium reflecting the rate increase.
Your Initial Premium is based on Your age when the Policy was issued, plus the p = m for any benefits that You
have added since then, and/or minus the premium for any benefits that You h since Your Policy was
issued.
for a Substantial Premium
Over Initial fiver Initial
a Premium �' Premium
and under
200%
30 - 34
190%
35 - 39
170%
40 - 44
150%
45 - 49
130%
Coverage
If a Trigger for a S to Pr i Increase should occur and You are unable to afford the increased premium, We
will notify You that You m elect :
(1) reduce Your current benefits, but not less than an amount that is currently available, so that required
premium payments are not increased, or
(2) convert Your coverage as provided under the Shortened Benefit Period described below. This option must be
elected anytime during the 120 days following the Premium Due Date for the increased premium. However,
should Your Policy Lapse during this 120-day period, the Shortened Benefit Period will automatically take effect.
_
34%
74
32%
75
30%
76
28%
77
26%
78
24%
79
22%
80
20%
81
19%
82
18%
83
17%
84
16%
85
15%
86
14%
87
13%
88
12%
89
11%
90 and over
10%
Shortened Benefit Period
Your coverage will continue on a limited basis if this option is put into effect.
The daily benefit amounts available will be the same amounts available at the time Your Policy would have Lapsed.
The minimum benefit provided under this Shortened Benefit Period will be equal to 30 times Your Nursing Home
Maximum Daily Benefit at the time of Lapse.
OPTIONS
If You have a benefit increase option of any kind in force, the benefits available will NOT continue to increase.
The maximum benefit amount in force will be equal to all premiums paid, excluding waived premiums, for all Your
coverage combined.
All of the eligibility requirements, including waiting periods, elimination periods, or deductible amounts that applied in
order for an Insured Person to be eligible for payment of benefits at the time Your p&Wage would have Lapsed will
apply. To the extent that any such eligibility requirements and/or waiting periods weA isf d under Your coverage at
the time it would have Lapsed, they will also be satisfied under this Shortened B ey
The daily benefits payable under Your Policy and this Shortened Benefit Perio will ;rroteke daily benefits that
would have been payable under Your Policy if You had continued paying pre t I combined benefits
payable under Your Policy and this Shortened Benefit Period will not exceed the tot a enefi ` that would have been
payable under Your Policy if You had continued paying premiums.
Once the maximum benefit amount in force under this Shortened Be n Pen h ">S n paid, no further benefits will
be payable and all coverage will terminate.
If You have a benefit in force that allows coverage to be
date this Contingent Nonforfeiture Benefit will only appli
paid up or the waiver of premium begins. Otherwise this
up or on the date
TOL 1-CNFB 1001
kt►e up` r premiuhf to be waived for life at some future
if c er ge apses before the date the coverage becomes
�rtefit will' erminate on the date the coverage becomes paid
OPTfONS
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No Text
No Text
PLAN DESIGNS
Benefit Structure
Plan A
Plan B
Plan C
Maximum Daily Benefit
$ 60.00
$ 120.00
$ 150.00
Benefit Period
4 Year
6 Year
Lifetime
Elimination Period
60 Day
60 Day
30 Da
Maximum Benefit in Pool
$87,600.00
$262,800.00
Unlimited
Coverage Amounts
100% NH
100% NH
100% NH
NH — Nursing Home
50% AL
100% AL
100% AL
AL — Assisted Living
50% HHC
50% HHC
100% HHC
HHC — Home Health Care
Discounts Available
Worksite 10%
Worksite 10%
Worksite 10%
The worksite discount is available
Preferred
Preferred
Preferred
because the City sponsors the plan.
20%
20%
20%
The discount is provided to all eligible
Married
Married
Married
individuals.
40%
40%
40%
Rate Guarantee
3 Years
3 Years
3 Years
Standard Benefits Included
All
All
All
Waiver of Premium
NH Bed Reservation
Hospice
Contingent Nonforfeiture
Care Coordination Benefit
All
All
All
Monthly Home Care
Respite Care
Therapeutic Device
Home Modifications
Medical Alert System
Care Giver Training
Benefit Increase
Individual Choice
Individual Choice
Individual
Option (BIO)
Choice
Simple —Automatic 5%
May choose no
May choose no
Compound —Automatic 5%
BIO or any of those
BIO or any of those
May choose no
Step -Rated — Increase annually by 5%
listed.
listed.
BIO or any of
each year until you reach the level
those listed.
desired.
Guaranteed Purchase — Offer the right to
purchase additional coverage without
evidence of insurability.
Payment Options
Payroll Deduct
Payroll Deduct
Payroll Deduct
Annual
Annual
Annual
Limited Pay
Limited Pay
Limited Pa
QUESTIONNAIRE RESPONSES
1. How long has your organization offered LTC coverage?
Transamerica has been selling LTC since 1989.
Proffitt Benefit Services has been selling LTC since 1992
2. How many contracts do you have currently in force?
There are 2,698 group contracts for LTC with Transamerica. As of year-end
2002, there are 57,352 individual contracts in place.
There are currently 37 contracts for LTC in place with Transamerica on the plans
sponsored by the City.
3. How many contracts have been cancelled in the past two years, and what has been
the primary cause of cancellations?
Transamerica has excellent LTC persistency. Their lapse ratio is under 1 %.
Transamerica does not terminate the relationship with the employer. The
employer sponsoring the plan would cancel a group contract. They may choose to offer a
different carrier or discontinue the plan.
Two Transamerica contracts, through the City, have been terminated since they
were sold. One terminated because the employee could not afford to pay the premium
when he lost his job. The other policyholder terminated her annually paid policy at the
end of the first year because she didn't have the annual premium to pay.
4. Besides employees, which family members are eligible for coverage?
Spouses, children over the age of 18, brothers, sisters, aunts, uncles, parents,
grandparents and in-laws are eligible for coverage AND receive the discount available
through the City.
5. How much in benefits has been paid by your organization during the past two
years?
Generally, LTC is considered to be a policy that pays benefits during the
retirement years. However, benefits can be paid at any age and often are. Current City
employees with LTC policies have, as of yet, not utilized their plan benefits. Specific
company wide claim numbers are not available.
6. What is Transamerica's financial rating?
A.M. Best A+ Superior
Standard & Poors AA Very Strong
Moody's Aa3 Excellent
Fitch AA+ Very Strong
7. What type of contracts do you offer?
The contract offered is "a qualified long term care insurance contract under
section 7702B(b) of the Internal Revenue Code of 1986, as amended." It is guaranteed
renewable and non -participating. See Section Eight for a sample contract.
8. Please provide a side -by -side comparison of your various plan options.
See chart attached at end of questionnaire.
9. How are benefits funded?
Benefits are traditional LTC benefits, funded by paid premiums and income on
such premiums. The benefits are not linked to other products/policies.
10. Will you accommodate payroll deducted contributions? Will you permit a single
annual payment at a discounted rate?
Per our agreement with the City, payroll deduction is available for employees
their spouses and children living at home. All other policies are paid through PAC or
discounted annual payment.
Currently there are 7 employees and 5 spouses paying annually for their policies, 4
employees or spouses are paying PAC and the balances of policies (21) are through
payroll deduction.
11. Will you provide a toll free telephone number for employees to call with questions
about claims and plan provisions?
Proffitt Benefit Services — 866-796-9471
Transamerica — 866-745-3544
12. Please indicate the method used to calculate premiums. Do premiums remain stable
through the life of the contract?
The rates in this proposal are based on age, smoker status, plan design chosen and
available discounts.
During the underwriting process individual premiums may vary from the provided
rates based on current medical conditions. The applicant agrees to the premium
adjustment or refuses the coverage. We currently have 2 spouses waiting for health
issues to resolve so they can apply and then both they and their spouse will receive the
married discount.
Premiums are guaranteed renewable. The premium will not be raised because of
payment of benefits or increase in age. There is an initial 3-year rate guarantee.
Transamerica "can change your premium based on your premium class, subject to
approval by the Department of Insurance, if required. Premium class means a population
segment classified by our actuaries as having similar characteristics, such as issue age,
issue year, rate classification and selected benefit options or other criteria."
Additionally, plans can be purchased that provide for payment on other than a
lifetime basis thereby providing a cut-off point on potential rate increases.
13. Additional checklist items.
None
PLAN DESIGNS
Benefit Structure
Plan A
Plan B
Plan C
Maximum Daily Benefit
$ 60.00
$ 120.00
$ 150.00
Benefit Period
4 Year
6 Year
Lifetime
Elimination Period
60 Day
60 Day
30 Da
Maximum Benefit in Pool
$87,600.00
$262,800.00
Unlimited
Coverage Amounts
100% NH
100% NH
100% NH
NH — Nursing Home
50% AL
100% AL
100% AL
AL — Assisted Living
50% HHC
50% HHC
100% HHC
HHC — Home Health Care
Discounts Available
Worksite 10%
Worksite 10%
Worksite 10%
The worksite discount is available
Preferred
Preferred
Preferred
because the City sponsors the plan.
20%
20%
20%
The discount is provided to all eligible
Married
Married
Married
individuals.
40%
40%
40%
Rate Guarantee
3 Years
3 Years
3 Years
Standard Benefits Included
All
All
All
Waiver of Premium
NH Bed Reservation
Hospice
Contingent Nonforfeiture
Care Coordination Benefit
All
All
All
Monthly Home Care
Respite Care
Therapeutic Device
Home Modifications
Medical Alert System
Care Giver Training
Benefit Increase
Individual Choice
Individual Choice
Individual
Option (BIO)
Choice
Simple — Automatic 5%
May choose no
May choose no
Compound —Automatic 5%
BIO or any of those
BIO or any of those
May choose no
Step -Rated — Increase annually by 5%
listed.
listed.
BIO or any of
each year until you reach the level
those listed.
desired.
Guaranteed Purchase — Offer the right to
purchase additional coverage without
evidence of insurability.
Payment Options
Payroll Deduct
Payroll Deduct
Payroll Deduct
Annual
Annual
Annual
Limited Pay I
Limited Pay
Limited Pa