Plan Highlights
Services
The VSDP Long-Term Care Plan covers nursing home care, hospice care, assisted living care, community-based care and at-home care, among other services. Your caregiver also may be eligible for assistance under the plan. The maximum daily benefit amount is $96 with a lifetime maximum of $70,080. If you are eligible for the Commonwealth of Virginia (COV) Voluntary Group Long Term Care Insurance Program or have other long-term care insurance, you may be able to coordinate with the VSDP Long-Term Care Plan to obtain even more coverage.
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 illumifin Corp. to administer benefits under the plan. For more information about your coverage or to apply for benefits, contact illumifin Corp. 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 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 illumifin Corp. at 1-800-761-4057. You will be billed directly for the premiums. For more information, see If You Leave Your Position.
Plan Benefits
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% 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% 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% 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% 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 practitioners.
Adult Day Care Center
- Up to 50% of the maximum daily benefit amount ($48).
- Community-based, group setting for adults.
Hospice Care Agency
- Up to 50% 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% 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 illumifin Corp. 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% 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% of the maximum daily benefit amount ($96) for up to 21 days per calendar year.
Respite Care
Up to 50% 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.
Additional Plan Features
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% 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.
Applying
How to Apply
VRS has contracted with illumifin Corp. to coordinate your benefits under the plan. Contact illumifin Corp. at 1-800-761-4057 within 60 days of being certified as eligible for benefits. A family member or friend may call on your behalf. To learn more about qualifying for benefits, plan highlights, plan features and coverage after you leave employment, review the VSDP Handbook for Participants.
