Building your coverage under a Group Long Term Care Insurance Policy underwritten by Aetna Life Insurance Company (Aetna)

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1 Building your coverage under a Group Long Term Care Insurance Policy underwritten by Aetna Life Insurance Company (Aetna) When you make the decision to purchase Long Term Care (LTC) insurance, you are taking an important step in helping protect your personal financial plan. That is why understanding the long-term care coverage available to you and how it works is very important. When you enroll, you establish the pool of money that will be available to pay benefits for qualified longterm care services you may need once you are eligible for benefits. Your lifetime Maximum Benefit or pool of money is determined by the following three steps: Step one: Select a Daily Benefit Amount (DBA) Your DBA is the maximum dollar amount the plan will pay in any single day for covered expenses. You select a DBA between $50 $300 in $1 increments.* Step two: Select a Lifetime Maximum multiplier You may select from the following number of years (2 or 5) for your plan.* Step three: Calculate your pool of money by multiplying your DBA by the Lifetime Maximum multiplier, and then by multiplying this amount by 365: Example: You select a $100 DBA Multiply the Lifetime Maximum multiplier x 365 Multiply your selected DBA x the amount of days from step 2 Based on selected DBA of =$100 with a Lifetime Maximum multiplier of 5 years x 365 days (1825 days) = $182,500 Pool of Money * The amount of benefits provided depends upon the plan selected. The premium will vary with the selected benefit amount. Eligibility for Benefits You are eligible for benefits when a Licensed Health Care Practitioner (LHCP) certifies that you are unable to perform two of six Activities of Daily Living that is expected to last at least 90 days or have a Severe Cognitive Impairment, such as Alzheimer s disease. Activities of Daily Living are bathing, dressing, eating, transferring, continence and toileting. A LCHP will prescribe a Plan of Care that meets your needs. Single Deductible/Elimination Period: Long Term Care Insurance benefits are payable once you are eligible for benefits and have met the Deductible Period. Only one 90-day Deductible/Elimination Period needs to be met, regardless of how often and for what reason you become eligible for benefits.

2 Aetna Group Long Term Care Insurance policies offer flexible coverage options. The benefits are paid daily up to a certain percentage based on a variety of care settings. Care Settings Nursing Care Facility Assisted Living Facility Hospice Care Facility Home Health Care Adult Day Care Center Hospice Care Agency Care received at a nursing care facility, including skilled and custodial care. Personal support services and care provided in an assisted living facility. Care for terminally ill individuals, provided in a hospice facility. 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. Care provided during the day for adults, usually in a community setting. Care for terminally ill individuals, provided at home by a home care agency. Benefit Amount 100% of your DBA 100% of your DBA Home Care Related Benefits Benefit Home Modification Assistive Equipment and Technology Modifications made to your place of residence to help you remain there; such as a wheelchair ramp, shower grab bars, widened door frames. Equipment designed to support independent functioning; such as medication, dispensing device, emergency response unit, wheelchair. Benefit Amount the greater of 10 times the DBA or $1000 amount paid once a month

3 Your Group Long Term Insurance Plan automatically includes four benefits that don t reduce the Lifetime Maximum Benefit including: Transitional Care Informal Care Informal Caregiver Training Respite Care Provides a cash benefit to support the transition from being self-sufficient to needing care. Provides for personal care in your home by family members, neighbors or other private-hire caregivers. Provides for training of your personal caregiver by health professional. Provides for substitute at-home care while your usual caregiver takes a break from providing care. One time payment equal to 3 times your DBA. Paid automatically as a cash benefit and can be used any way that you want 25% of your DBA for up to 50 days per calendar year One payment per claim period up to cost of training, up to 3 times your DBA for up to 21 days per calendar year Additional Benefits At Aetna we want to ensure that you get the most from your long-term care insurance plan. That is why we include these important benefits: Alternate Care For bills submitted for which no Long Term Care Benefit is otherwise payable under this Plan, Aetna (at its discretion), may pay a benefit under the Alternate Care Benefit. 100% or 50% of the DBA depending on Aetna s determination of which Long Term Care Benefit, as defined under this Plan, most closely relates to the provider rendering the care

4 Additional Benefits (continued) Inflation Protection (Future Purchase Inflation Protection Increases) Spousal Discount Portability Restoration of Benefits Premium Waiver Nationwide Discounts Contingent Lapse Benefit Gives you the opportunity to increase your Daily Benefit Amount every 2 years on a 5% compound basis without answering questions about your health. Offers a 10% discount for you and your spouse when you both enroll and your coverage becomes effective. Allows you to continue your coverage at the same group rates if you retire or leave the company. Restores your Lifetime Maximum Benefit or pool of money by the amount paid out in benefits when you recover from an eligible loss and begin making premium payments again. The Restoration of Benefits is contingent on being out of claim for 90 days. Allows you to stop making premium payment after you are eligible for benefits and have met the Deductible/Elimination Period. Payments resume 90 days after you are no longer eligible for benefits. Provides access to nationwide discounts of up to 10 to 30 percent on providers such as nursing homes and assisted living facilities. If you do not select nonforfeiture at enrollment, then, if a substantial premium rate increase occurs, you may continue coverage at current benefit levels by paying the new premium amount; Or elect to: Decrease your Daily Benefit Amount (Decreased Benefit Option) resulting in a decrease in your Lifetime Maximum Benefit; or Convert your coverage to paid-up status (Paid-up Benefit Option). Optional Benefits (available to you at additional cost) Nonforfeiture Benefit If you stop paying the premium within the first three years of your Long Term Care (LTC) coverage effective date, all premium and benefits are forfeited. However, if you stop paying premium after your LTC coverage has been in effect for three or more years, Aetna will hold a benefit for you. Your DBA will stay the same, however your new Lifetime Maximum will be greater of: (1) 100% of premiums paid, or (2) one month of benefits (30 times your DBA).

5 Support Services We have a wide range of coverage options to fit your situation and budget. Exploring coverage options for long-term care services can be confusing. That is why Aetna s customer service representatives and care coordinators are there for you. Care Coordination Our care coordinators serve as your single point of contact for you and your family members to help throughout the claim process. We will explain long-term care coverage options and help you identify appropriate care facilities and resources. Customer Service Dedicated customer service representatives will assist you with your questions regarding your enrollment and plan coverage. Enrollment Eligibility Employees Full-time, part-time or other employees, as determined and defined by the participating employer, who work 20 or more hours per week are eligible to enroll. However, if you are ill, injured or on a medical leave of absence and away from work on the date that coverage would otherwise become effective for you, then the effective date of your coverage will be delayed to the first of the month following the date you return to work for at least 5 consecutive working days and you are in an eligible class. Also, if your employment status changes after you submit your enrollment form, you must notify Aetna immediately, as this may affect your eligibility coverage. Other Eligibles Employees spouses, parents, parents-in-law, retirees, retirees spouses, and surviving spouses are also eligible to apply for coverage. Enrollment Period Employees Initial Enrollment: Active employees who enroll during a special enrollment period may do so without providing proof of good health. New Hires/Newly Eligible: You may enroll within 60 days of your date of hire without providing proof of good health. Employees enrolling after the special enrollment period or after the initial eligibility period may enroll at anytime and are required to complete a medical questionnaire. Approval by Aetna is required before coverage becomes effective. Other Eligibles may enroll at anytime and are required to complete a medical questionnaire. Approval by Aetna is required before coverage becomes effective. Enrollment forms must be received by Aetna on or before the last day of the applicable enrollment period, as noted above. Your age will be determined on the day Aetna receives your enrollment form.

6 How to Enroll: To obtain enrollment information online simply visit 1. Employees can enroll, without answering medical questions, during a special enrollment period or within 60 days of hire. Review the Personal Worksheet and Disclosure Statement and proceed to enroll. After the initial open enrollment, employees can enroll anytime by completing a short Medical Questionnaire. 2. Other Eligibles can enroll by completing the appropriate Medical Questionnaire Enrollment Form (please carefully read and sign all sections). 3. Select your coverage options: a) Choose a Daily Benefit amount b) Select a Lifetime Maximum c) Select Optional Benefit (available to you at an additional cost) Nonforfeiture 4. Return your enrollment form to (make a copy for your records): Aetna Life Insurance Company Long Term Care P.O. Box 5712 Hopkins, MN Or: To order an enrollment kit: Call the Aetna LTC Customer Service Team at or order online at For more information and rates, please call an Aetna LTC Representative at Monday to Friday from 8 am to 8 pm, ET or visit the Commonwealth of Virginia LTC website at This material is for informational purposes only and contains only a partial, general description of plan benefits and does not constitute a contract. Refer to your plan highlight information (in the enrollment material) for more information. The Certificate of Insurance that is issued when coverage becomes effective contains more detailed statement of the terms and conditions of your insurance coverage. Please note that plan provisions may vary in order to satisfy state requirements. Coverage under this group long term care insurance policy has exclusions, limitations, reductions of benefits and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage contact Aetna. This group Long Term Care insurance policy is intended to be tax-qualified. While this material is believed to be accurate as of the print date, it is subject to change. The following policy form numbers apply: GR-700-WQF for MD & WA; GR-700-WFQ for CA, KS, MN and PA; GR-700 for NJ and NY. GR-70-W OR Ed for OR. For all other states including OK, TX and VA, the policy form number is GR-700-W and the certificate form number is GR-70-W.

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