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Virginia Sickness and Disability Program Long-Term Care Plan (State Employees)

If the member is a state employee in VRS Plan 1, VRS Plan 2 or the Hybrid Retirement Plan, the State Police Officers’ Retirement System (SPORS) or the Virginia Law Officers’ Retirement System (VaLORS) and participates in the Virginia Sickness and Disability Program (VSDP), the member is covered under the VSDP Long-Term Care Plan at no cost to the member.

VSDP Long-Term Care Plan Services

Covered services include nursing home care, hospice care, assisted living care, community-based care and at-home care, among others. The member’s caregiver also may be eligible for assistance under the plan. The maximum daily benefit amount is $96 with a lifetime maximum of $70,080.

VRS has contracted with the Long-Term Care Group, Inc. to coordinate benefits under the plan. The member may contact the Long-Term Care Group, Inc. toll-free at 1-800-761-4057 within 60 days of being certified as eligible for benefits. A family member or friend may call on the member’s behalf.

Plan Features

Name Description
Plan Sponsor

The Virginia Retirement System (VRS) manages the long-term care program as part of the Virginia Sickness and Disability Program (VSDP).

Plan Administrator

VRS has contracted with the Long Term Care Group, Inc. to administer benefits under the plan. For more information about your coverage or to apply for benefits, contact the Long Term Care Group, Inc. toll free at 1-800-761-4057, or P.O. Box 64011, St. Paul, Minnesota 55164-0011.

Eligible Participants

You are covered under the VSDP long-term care plan if you participate in the Virginia Sickness and Disability Program (VSDP).

Benefit Eligibility

You are eligible for benefits when a licensed health care practitioner certifies that you:

  • Are unable to perform at least two of six Activities of Daily Living without substantial assistance; or
  • Have a severe cognitive impairment, such as Alzheimer's disease, requiring substantial supervision.
Daily Benefit Maximum Amount

$96 per day. This is the maximum amount of coverage the plan will pay for covered services in any single day.

Lifetime Maximum Amount

$70,080. The lifetime maximum amount is based on the maximum daily benefit amount of $96 multiplied by 730 days (two years): $96 x 730 days = $70,080. Your coverage ceases when your total benefit payouts reach $70,080, regardless of how long you receive benefits.

Premiums

Free of charge as a VSDP participant.

How Benefits Are Paid

Your coverage pays a benefit equal to the lesser of:

  • Actual qualified expenses incurred per day; or
  • Allowable daily benefit amount.
Waiting Period

Your benefits are payable 90 calendar days after the beginning of each incident certified by a licensed health care practitioner as eligible for VSDP long-term care benefits.

Portability

If you leave your VSDP-covered position, you have the option to continue coverage in the VSDP Long-Term Care Program at group rates. You must elect to continue your coverage within 60 days of leaving VSDP-covered employment. Call the Long Term Care Group, Inc. toll free at 1-800-761-4057. You will be billed directly for the premiums.

Name Description
Note: Your coverage pays the lesser of actual qualified expenses incurred per day or the allowable daily benefit amount.
Nursing Care Facility

Up to 100 percent of the maximum daily benefit amount of $96.

Provides skilled and custodial care in a nursing care facility that meets all applicable licensing requirements.

Assisted Living Facility

Up to 100 percent of the maximum daily benefit amount of $96.

Personal services and care in an assisted living facility that meets all applicable licensing requirements.

Hospice Care Facility

Up to 50 percent of the maximum daily benefit amount ($48).

Provides care if you are terminally ill in a hospice facility that meets all applicable licensing requirements.

Home Health Care

Up to 50 percent of the maximum daily benefit amount ($48).

Custodial care, nursing care, therapy and homemaker services provided in your home by nurses, social workers, home health aides or other licensed or certified professionals.

Adult Day Care Center

Up to 50 percent of the maximum daily benefit amount ($48).

Community-based, group setting for adults.

Hospice Care Agency

Up to 50 percent of the maximum daily benefit amount ($48).

Provides care if you are terminally ill in your home by a hospice care agency that meets all applicable licensing requirements.

Alternate Plan Benefit

Up to 50 percent of the maximum daily benefit amount ($48).

May cover an Alternate Plan of Care developed by your licensed health care practitioner, provided you, your physician and the Long-Term Care Group, Inc. agree to the plan.

Transitional Care

One-time cash payment equal to three times the maximum daily benefit amount ($288) to support your transition from independent living to long-term care. You may use this one-time payment in any way you wish.

Note: This benefit does not reduce your lifetime maximum benefit.

Informal Care Benefit

Up to 25 percent of the maximum daily benefit amount ($24) for up to 50 days per calendar year to provide for personal care from a family member, neighbor or private caregiver you hire.

Note: This benefit does not reduce your lifetime maximum benefit.

Informal Caregiver Training

One payment each time you are receiving benefits to provide for the training of your personal caregiver by a licensed health care practitioner. The payment is equal to the lesser of the actual amount of the cost of training or three times the maximum daily benefit amount ($288).

Note: This benefit does not reduce your lifetime maximum benefit.

Bed Reservation

If you are in a covered facility, such as a nursing home, and you have to be hospitalized, the plan covers up to 100 percent of the maximum daily benefit amount ($96) for up to 21 days per calendar year.

Respite Care

Up to 50 percent of the maximum daily benefit amount ($48) for up to 21 days per calendar year to provide for a substitute in-home caregiver while your usual caregiver is on leave.

Note: This benefit does not reduce your lifetime maximum benefit.

Name Description
Care Advisory Services

Helps identify long-term care services and programs available in your area that can best meet your care needs. Services provided by care advisors are voluntary.

Future Purchase Inflation Protection

Your coverage is automatically adjusted for inflation on a 5-percent compound basis of your daily benefit amount at least every five years.

World-Wide Coverage

If you incur charges for services equivalent to those covered under this plan outside the United States, its territories or Canada, you will be reimbursed for these charges. The amount of the reimbursement will equal the benefit amounts allowable under your plan for up to 365 days of services.

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