Other Benefits

UNUM Long-Term Care Insurance - Valassis Direct Mail Associates Paid Through PeopleSoft

Most medical coverage (including Medicare) does not cover the cost of nursing homes or other services that provide assistance with some of the normal activities of daily living. The cost of such care can easily use up your personal savings.

Valassis offers a Long Term Care (LTC) Insurance Plan that can help ease the financial burden of such care for you and your family. LTC insurance coverage provides benefits if you can no longer live independently due to illness, injury or the effects of aging. LTC insurance covers qualified services not typically covered by medical or disability benefits, such as care received in your home, qualified nursing homes, adult day care centers and assisted living facilities for the cognitively impaired.

The LTC insurance plan consists of insurance coverage provided by UNUM Life Insurance Company of America under Policy Number 553006. Coverage provisions and costs may change periodically. Please link to UNUM for additional details regarding the plan.

Eligibility
You are eligible for coverage on the first day of the month following your date of hire if you are an active full-time associate scheduled to work at least 30 hours per week.

You are eligible to elect coverage for yourself. Your spouse and other family members between age 18 and age 80—adult children, siblings, parents, parents-in-law, grandparents and grandparents-in-law—may also apply for coverage.

Enrollment
If, as a newly eligible associate, you enroll within 30 calendar days of when you are first eligible, in most cases you will not have to provide satisfactory evidence of insurability.

You will be required to provide evidence of insurability (that is, complete a medical questionnaire) and perhaps have a face-to-face medical assessment if you:

• Apply at a later date,

• Choose to buy facility benefit coverage for more than $4,000, or

• Choose the unlimited duration option.
  

Satisfactory evidence of insurability and, in some cases, a face-to-face medical assessment, is always required for your spouse, adult children, siblings, parents, parents-in-law, grandparents and grandparents-in-law when they apply for coverage.

Evidence of insurability must be provided by completing the Long Term Care Insurance Application (medical questionnaire), which is available within an enrollment packet distributed through the Associate Resource Center. Contact the ARC at 1-877-238-6847, or e-mail your request to ARC@valassis.com.

When you enroll, you will be sent a certificate of coverage. If, after examining the certificate, you are not satisfied for any reason, you may withdraw your enrollment by returning your certificate within 30 days of its receipt. When UNUM receives your certificate, your insurance will be considered void from its effective date and any premium contribution(s) paid will be returned to you.

Once you are enrolled, you may apply at any time to increase coverage by completing a new Benefit Election Form and providing satisfactory evidence of insurability.

When Coverage Takes Effect
If you enroll when you are first eligible and elect coverage that does not exceed evidence of insurability limits, your coverage will take effect on the first day of the pay period in which deductions are taken from your pay.

If evidence of insurability is required, coverage will take effect once your application is approved by UNUM. If approval is between the first and the fifteenth of the month, coverage will begin the first of the month following the date of approval. If approval is between the sixteenth and the end of the month, coverage will begin the first of the second month following the date of approval.

If you are not at work on the date your insurance would be effective, your coverage effective date will be delayed until the first day of the month following your return to work on a regular basis.

If your dependent is disabled on the date the coverage would be effective, the effective date will be delayed until the first day of the month following the date your dependent is no longer disabled, provided he or she is still eligible for LTC insurance coverage.

Elimination Period - the plan has an "elimination period" of 90 consecutive days before benefits may be paid. During this period you and your covered dependent must be disabled and under the regular care of a physician.

Cost of LTC Insurance
The premium amount for LTC insurance is age-related and is higher for older individuals. The cost is based on your insurance age, which is your age on the date you sign the enrollment form. Premiums will be adjusted if your age has been misstated on the application for coverage.

Premiums to cover you and your spouse are paid through your regular after-tax payroll deductions. Premiums for other covered dependents are paid directly to UNUM.

If you leave Valassis or go on a leave of absence, you and any covered family members may continue LTC insurance coverage by paying premiums directly to UNUM, as long as the lifetime maximum benefit has not been used up. You will need to obtain a continuation of coverage form from the UNUM.

Premium Waiver
While you are receiving LTC insurance benefits, you will not be required to pay premiums toward your LTC insurance coverage. Premiums will have to be paid, however, during the elimination period (the 90-day period before benefits begin). Also, if your spouse or family members are covered, they will have to continue paying their premiums.

If you are receiving professional home care services, and you do not receive these services for a period of 30 consecutive days, premium payments will again become due.

Premiums are not waived while you are receiving a payment for respite care—that short period of time during which formal care is provided to you to allow your caregiver a break from his or her responsibilities.

Long Term Care Plan Benefits
LTC plans are designed to provide coverage for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance or personal care services. These services are provided in a setting (e.g., a nursing home, in the community, in your home) other than in an acute care unit of a hospital. Coverage is subject to policy limitations, benefit maximums and elimination periods.

Your LTC plan also provides coverage for severe cognitive impairment, not necessarily related to the inability to perform activities of daily living. Severe cognitive impairment means that you have lost the ability to reason and suffer a decrease in awareness, intuition and memory. Examples of conditions that may cause severe cognitive impairment include Alzheimer’s disease, multi-infarct dementia, brain injury, brain tumors and other such structural alternations of the brain.

The amount of your monthly benefit will be based on the coverage options you chose and the place of residence used for long-term care. If your coverage includes professional home care services, the benefit payment will be based on the number of days you receive these services.

Qualifying for Benefits
You qualify for LTC benefits after:

• You become disabled.

• You begin receiving:

  • Services in a long-term care facility or assisted living facility,

  • Professional home care services,

  • Total home care.

• You have satisfied your elimination period.
  
  
• A physician has certified that you are unable to perform, without substantial assistance from another individual, two or more activities of daily living—bathing, dressing, toileting, transferring (from bed to chair, for example), continence, eating—for a period of at least 90 days, or that you require substantial supervision by another individual to protect you and others from threats to health or safety due to severe cognitive impairment. (You will be required to submit a physician’s certification every 12 months.)
  
• If you have an existing loss of activities of daily living or severe cognitive impairment on your effective date of coverage, that loss or impairment will be eligible for coverage only if you recover from that loss or impairment. UNUM must receive acceptable proof of your recovery, such as a physician’s statement or an assessment.

LTC Insurance Options
Following are the choices you will need to consider when you enroll for long-term care coverage:

Once you review the choices above, you may choose among four plans representing increasing levels of care. You may choose the plan that best fits your lifestyle needs and budget. You also have to choose a facility monthly benefit amount ($1,000 through $6,000) and a facility benefit duration (three years, six years, unlimited), as noted above.

Following are brief descriptions of the different levels of care available to you.

Long-term care/nursing home facility—Covers care in an institution or distinctly separate part of a hospital that provides skilled, intermediate or custodial care under state licensing and certification laws.

Professional home care—Includes visits to your home by a licensed home health care provider during which skilled nursing care, physical, respiratory, occupational, dietary or speech therapy or homemaker services are provided.
Total home care—Includes professional home care services, as well as care received from any care provider of your choosing, including relatives and friends who provide care in your home.

Nonforfeiture option—If your coverage lapses due to nonpayment of premium after your coverage has been in force for three years, you will be eligible for a nonforfeiture benefit. Your coverage will continue in force with the same level of benefits, except for a reduction in your lifetime maximum amount.

Compound inflation protection option—If you choose this option, your monthly benefit amount will increase on January 1 by 5% of the monthly benefit in effect on that January 1. Your remaining lifetime maximum benefit amount will also increase. Increases will be automatic and will occur regardless of your health and whether you are disabled. Your premium will not increase due to automatic increases in your monthly benefit amount.

Here is a sample comparison of monthly benefits (illustrative purposes only) with and without the compound inflation protection option.

Elimination Period
You must wait 90 days before LTC insurance may pay benefits for covered charges incurred after the 90 days. The 90-day elimination period begins on the date that UNUM certifies you for benefits. You must remain certified for benefits throughout the elimination period. This time period must be satisfied only once during the life of your plan.

You may be reimbursed for covered charges incurred after completing the elimination period requirement as long as you remain certified for benefits.

Preexisting Condition
A preexisting condition is any condition for which you received medical treatment, consultation, care or services, including diagnostic measures for the condition, or took prescribed drugs or medicines during the six months prior to the date your coverage began.

If you have been treated or have received care or consultation in the six months before your effective date, and you then suffer a loss in the six months after your effective date of coverage and that loss is directly related to a preexisting condition, no benefit will be payable for that loss during the first six months after your coverage begins. This preexisting condition limitation applies to all insurance that does not require evidence of insurability.

If You Die
When UNUM is notified of your death it will refund to your estate, on a prorated basis, any part of the premium you paid that applies to the period after your death.

If you die and your spouse is enrolled for coverage, he or she may continue coverage by making arrangements directly with UNUM.

Taking Your LTC Insurance With You
Your LTC insurance coverage is portable; that is, you may keep your coverage in effect if you retire or otherwise leave employment with Valassis, provided you make this election within 31 days of your termination date. You must make arrangements to pay premiums directly to UNUM. Your covered family members may also continue coverage as long as they continue to pay their premiums to UNUM when due, and if they have not used up their lifetime maximum benefit.

What's Not Covered Under LTC Insurance
UNUM will not make long-term care payments to you for:

• A disability caused by war (declared or undeclared) or any act of war

• A disability caused by attempted suicide (while sane or insane) or self-destruction

• A disability caused by or resulting from the commission or attempted commission of a felony

• Disabilities or confinements during which you are outside the United States, its territories or possessions for longer than 30 days

• A disability caused by alcoholism or drug addiction

• A period in which you are confined in a hospital other than if you are confined in a nursing facility that is a distinctly separate part of a hospital

• A disability caused by psychological or psychiatric or mental conditions, regardless of cause, which include:

  • Depression

  • Generalized anxiety disorders

  • Personality disorders

  • Schizophrenia

  • Manic depressive disorders

  • Adjustment disorders and other conditions that are usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs or similar methods of treatment

• Medicare deductibles and coinsurance
  UNUM will make payments to you for conditions that are not psychological, psychiatric or mental in nature, including Alzheimer’s disease or similar forms of irreversible dementia.

Other Information About Your LTC Plan
If You Are on an Authorized Leave of Absence
If you are on an approved paid leave of absence, your premium will continue to be deducted from your paycheck. If you are on an approved unpaid or extended leave of absence, you may continue your LTC insurance coverage, provided you continue to pay the premium. You must make payment arrangements directly with UNUM. If you decide not to return to work, you can arrange continued LTC insurance coverage directly with UNUM.

Under the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA), associates who are called to national active military duty are entitled to a leave of absence for military service, with reinstatement rights. If you are a participant in the Long Term Care Plan, your coverage will continue as long as you continue to pay your premiums. If your pay is discontinued, premiums must be remitted directly to UNUM. If you drop coverage, you may reenroll when you return to work, subject to satisfactory evidence of insurability. Your premiums will be based on your insurance age at the time coverage is resumed.

When Coverage Ends
Your LTC insurance coverage ends on the earliest of the following dates:

• The date the policy ends,

• The date you are no longer an active full-time associate with Valassis,

• The date you no longer work for Valassis,

• The end of the period for which premiums were last paid to UNUM for your coverage,

• The date your total benefit payments equal your lifetime maximum amount, or

• The date you die.

Extension of Benefits
If you are confined in a nursing home or assisted living facility on the date your insurance ends, UNUM will consider charges you incur after that date as though they were incurred while you were insured, provided that:

• You remain continuously confined in the nursing home or assisted living facility from the date your insurance ends until the date the charge is incurred, and

• On the date your insurance ends, a benefit period is in effect.
  
  Benefits payable under this provision are subject to all the provisions of the policy, including the lifetime maximum benefit. No benefit will be payable under the policy for any charge incurred after your insurance ends, except as provided in this Extension of Benefits provision.

Conversion Privilege
If you terminate employment or retire, you may continue coverage under this policy by paying premiums directly to UNUM. If Valassis terminates this group policy and it is not replaced by another group long-term care policy, you may be able to continue coverage under a conversion policy at group rates.

Election for converted coverage must be made within 31 days of the date the group coverage would otherwise end. Any premium must be paid directly to UNUM for converted coverage to be continued.

How to File a Claim
To receive benefits under the plan, you will need to call UNUM at 888-868-6745. Appropriate forms will be sent to you.

Benefits under LTC insurance are payable only for covered charges incurred while you are certified for benefits and have met the elimination period requirements. You must provide proof of a claim for benefits to UNUM in writing.

Proof of claim must include all of the following (and be satisfactory to UNUM):

• Information that identifies the insured person receiving long-term care services,

• The date(s) expenses were incurred that are the basis for the claim,

• A description of the type of long-term care services received, and

• Information on the provider of the long-term care services.

All claims should be submitted to UNUM within 90 days after the date the insured person incurred the expense that is the basis for the claim.

UNUM will pay benefits directly to the provider of long-term care services, if you request UNUM to do so. If you do not make such a request, UNUM will pay these benefits directly to you or to your legal representative.

Review of Claim Denial
If your claim for benefits under the policy is denied, you or your authorized representative will receive a written notice giving the reason for the denial. You will then be entitled to a review of that claim denial if:

• You make written request for such a review, and

• You sent the request to UNUM within 60 days after the receipt of the denial.

UNUM will then review and make a final decision with respect to the claim appeal for benefits under the LTC insurance policy. This decision will be in writing and, if it is a denial, will include specific reasons for the denial.

The decision will be made promptly—usually not later than 60 days after UNUM receives the request for review.

Information and Referral Service
As a participant in the LTC Plan, you have access to LTC Connect, a confidential telephone service where you may speak with trained specialists who can answer your questions about long-term care services or provide referrals. You may also schedule a visit from a health care professional who will assist you in developing a plan of care or provide a home safety check. You access LTC Connect by calling 888-868-6745, e-mailing Services for Independent Living at sil@unum.com or by logging on to www.unum.com.

Amendment, Renewal and Termination
The LTC insurance policy may be amended or terminated at any time by written agreement between UNUM and Valassis. If the LTC insurance policy is terminated, you may continue coverage under a replacement policy (see Taking Your LTC Insurance with You) or under a conversion policy (see Conversion Privilege).