Long-Term Care Plan Frequently Asked Questions

This information is intended to supplement but not replace the information in the Long Term Care booklets. Should there be a difference between this and the booklet, the booklet will prevail.

Who do I contact to open a claim?

CHCS Services, Inc. is the claims administrator. You may contact them at (888) 287-7116 to initiate a claim.

Top of page

Where do I submit expenses for processing?

Your receipts for expenses may be submitted to:

CHCS Services, Inc.
P.O. Box 13431
Pensacola, FL 32591-3431

Fax: (866) 383-5821

Top of page

Is there a web site that I can find information about the plan and my claims?

Yes, CHCS has made a portal available where members may view which plan they are in enrolled in, review plan documents, and obtain a claim submission packet. Members can also use the portal to view claims and receive messages from their case manager.

CHCS Portal

Top of page

Are there exclusions for pre-existing conditions?

Long-term care required due to a pre-existing condition is excluded.

  • A pre-existing condition is any that was diagnosed or treated during the 3 months before coverage started.
  • If you need care in the first 12 months of coverage due to a pre-existing condition, no benefits will be paid for that period of care.
  • If you need care in the first 12 months of coverage due to something other than a pre-existing condition, benefits are paid as normal.
  • If you need care after 12 months of coverage is covered, regardless of the cause.

Top of page

What do I need to do to qualify for benefits?

To qualify for benefits, the Bronze plan requires that you are incapable of performing two of the following five Activities of Daily Living (ADLs):

  • Eating – your ability to feed yourself
  • Dressing – your ability to put on or take of your clothes, fasten buttons or zippers
  • Toileting – your ability to get safely to and from the toilet and perform basic personal hygiene
  • Transferring – your ability to move in and out of a bed or chair
  • Walking – your ability to walk without someone's assistance

The Silver, Gold and Platinum plans require that you be incapable of performing two of the following six ADLs:

  • Eating – your ability to feed yourself
  • Dressing – your ability to put on or take of your clothes, fasten buttons or zippers
  • Toileting – your ability to get safely to and from the toilet and perform basic personal hygiene
  • Transferring – your ability to move in and out of a bed or chair
  • Continence – your ability to maintain control of bowel and bladder functions or if unable, the ability to perform associated personal hygiene (i.e., caring for a catheter or colostomy bag)
  • Bathing – your ability to wash yourself in a tub, shower or by sponge bath

The Silver, Gold, and Platinum plans also provide benefits for cognitive impairment (such as Alzheimer’s), which requires that you be supervised in order to perform the ADLs. Certification of medical necessity from a physician is required under all plans. Prior inpatient care is not required.

Top of page

What types of facilities will be covered?

The plans cover licensed nursing care facilities, in-home care provided by a licensed home health care agency, and adult day care. The Silver, Gold and Platinum plans also cover assisted living facilities and respite care. Care provided by family members or outside of the United States is not covered.

Top of page

When do benefits begin?

The deductible period is 90 days under all plans. You must receive 90 days of covered care before benefits are paid. You may be in any level of care or multiple levels of care to satisfy the 90 days. For example, you may be in home health care for 60 days and in a nursing home for another 30 days to meet the deductible period.

You do not need to receive care every day during the 90-day period. If you receive care only certain days of the week, you still receive credit for the full week of care toward the 90-day deductible.

Top of page

What is excluded under the LTC plan?

The plans do not cover long-term care required due to:

  • Alcohol or drug addiction
  • Acts of war, declared or undeclared
  • Suicide, attempted suicide or intentionally self-inflicted injuries
  • Mental or nervous disorders without demonstrative organic disease
  • Confinement in a government institution unless required to pay
  • Services provided when you are hospitalized
  • Services provided by someone who lives with you, is a member of your family, or who does not normally charge for services
  • Services covered by the retiree medical plan, Medicare or any law or government program, except Medicaid
  • Services provided outside the United States
  • Services because of past or present service in a government armed forces

Note that Alzheimer’s and other forms of dementia are covered.

Top of page

Will inflation protection be automatic or may it be elected at periodic intervals?

The Bronze and Silver plans have no inflation protection. The Gold plan has 5% simple inflation protection and the Platinum plan has 5% compound inflation protection. Inflation protection is automatic and associated benefit maximums (both daily and lifetime) will be adjusted annually on the date of your enrollment.

Top of page

When does inflation protection stop?

Inflation protection stops at age 85. The lifetime and daily benefit amounts reached by that date are locked in for the life of the policy.

Top of page

What will be required for proof of good health to buy up or elect LTC for the first time?

A simple health questionnaire asking for information about current health status will be required initially. Based on the questionnaire, you will either be approved or asked to provide more information in writing or in person or have a medical examination.

Top of page

Will premiums increase as I age?

No. Premiums are based on your age at retirement and while all premiums may increase, your premium will always be based on your age on the date you retired. If you elect coverage for your spouse, you pay a separate premium based on their age at your retirement.

Top of page

How often do the premiums increase?

Premiums are subject to review annually and may increase at any time the fund is insufficient to pay the expected claim costs. Premiums have not changed since the inception of the plan.

Top of page

Who insures the LTC plan?

The plans are insured by the retirement systems and claims are paid by the third party administrator.

Top of page

Can I use Medicare to cover LTC expenses?

Medicare covers some costs but the coverage is limited and approved only for short term periods. Neither Medicare nor the retiree medical plan cover lengthy nursing home stays or home care services for personal care needs.

Top of page

Can I use Medicaid to cover LTC expenses?

Yes but you must meet their financial eligible criteria which require you to spend down your assets. Under Medicaid, your choice of where you receive care may also be limited.

Top of page

Can I change my LTC coverage?

You may decrease your coverage, from Platinum to Gold for example, or drop coverage for your spouse at any time. You may never increase your level of coverage. You may apply for coverage for a new spouse within 120 days of the date of marriage.

Top of page

Is the LTC plan tax-qualified?

Yes. The plan is tax-qualified, which means any benefits paid by the plan are not taxable and you may be able to deduct the premiums from your income taxes.

Top of page