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See Attachment II In Appendix
Laws regulating the Partnership are found in the Welfare and Institutions Code (Not the Insurance Code). The detailed day-to-day rules for the Partnership are found in the regulations. However, Partnership policies are still LTCI policies, so they are also governed by most Sections of the California Insurance Code.
The following insurers presently participate in the Partnership plan, but this may change as more companies become interested. Note that these are all substantial companies.
“President Supports Removing Legislative Barriers
to Nationalizing Partnership Programs
The President’s budget that was released last month showed intent to overturn the Omnibus Reconciliation Budget Act (OBRA) of 1993, which limits Medicaid’s ability to disregard assets protected through the purchase of a Partnership policy. OBRA 93 disallows disregard of the protected assets for the purposes of estate recovery.
Unless OBRA is overturned, only the current Partnership programs (California, Connecticut, Indiana, and New York) are allowed to disregard assets both for the purposes of Medicaid eligibility and estate recovery. Removal of the legislative border would be a major step toward nationalizing the Partnerships and creating an opportunity for Medicaid asset protection for a policy purchased in one state to be honored by Medicaid programs outside of the state where the policy was purchased.”
The hope is that the federal government will allow additional states to begin Partnership programs and eventually, reciprocity between the states, one of the plan’s current weaknesses. If the Federal government overturns this section of OBRA an individual could purchase the plan in one state to be honored by Medicaid programs outside of the state where the plan was purchased.
California Partnership for LTC
California Partnership for LTC
Department of Health Services
Phone: 916-323-4253
Fax: 916-323-4238
Email: cpltc = dhs.ca.gov
Website: www.dhs.ca.gov/cpltc
CalPERS is a self-funded employee benefit program and by not being an insurance company allows them the flexibility in some cases not available to insurers who are bound by the California Insurance Code.
CalPERS is nationally known for its marketing success in Long Term Care Insurance, and has sold 136,300 Long-Term Care Insurance policies, of which over 6,300 are California Partnership policies.
The CalPERS (California Public Employee’s Retirement System) Long-Term Care Program is an additional option available to all California public employees and retirees including: city, county, and state employees, school teachers, legislators, judges, University of California employees and retirees. Also, eligible to apply are public employees’ and retirees’ spouses, parents, and parents-in-law.
Because of its flexibility, CalPERS has included new and innovative benefits and has improved on benefits normally offered on LTCI plans—such as monthly allowances for home care, compound inflation protection, a onetime elimination period, lifetime benefits, automatic three-year inflation upgrading, pot-of-money concepts, and care advisers, plus a return-of-premium death benefit, bed reservations, respite care, alternate care, and portability within the U.S.. Additionally, there are no maximum age limits to apply for coverage, and the minimum age depends on the practices of the public agency involved.
There are three basic plans with several sub-options:
This program is only available in California and therefore, the benefit limits are at or above, the state’s average cost of care. Both the Comprehensive and Partnership plans cover the full range of services, including personal care, homemaker visits, home care, and care in an assisted living facility or nursing home.
The “CalPERS Nursing Home Assisted Living Facility Only” plan does not provide home or community based care.
“CalPERS Comprehensive and Nursing Home/Assisted Living Plans” offer a 90-day elimination period and an integrated benefit allowance of either $142,350 or lifetime. With the optional inflation protection all benefits increase by 5% (compounded annually). If inflation protection is not chosen, members have the opportunity to increase their benefit limits every third year without having to provide evidence of insurability. (Note the participants are “members,” and not “insureds,” as CalPERS is not an insurance company.)
Premiums typically average 20% less than comparable private LTCI plans. For example, at age 65 the premium for the CalPERS Comprehensive plan with lifetime benefits and inflation protections is $177 per month. Most of these savings result from the direct marketing and self-funded, not-for-profit aspects of the program.
(NOTE: See CaIPERS Website for updated figures - www.calpers.ca.gov)
The CalPERS Partnership plans provide dollar-for-dollar asset protection from Medicaid (Medi-Cal) spend down, a 30-day elimination period and an integrated benefit allowance of either $40,150 or $80,300 and include 5% compounded inflation plans.
The following is an outline of benefits, with a deductible period of 30 calendar days for each plan:
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DAILY NURSING HOME ASST.LIVING HOME & TOTAL COVERAGE
BENEFIT (100% of Daily Ben). (70% DailyBen.) COMMUNITY CARE AMOUNT
(DailyBen.) (15 times DailyBen.)
$110 $110 $77 per day $1,650 Month $40,150 or $80,300
$130 $130 $91 per day $1,950 Month $47,450 or $109,500
$150 $150 $105 per day $2,250 Month $54,750 or $109,500
The prospect may become uninsurable.
The premium goes up each year.
The overall cost of the policy over the insured’s lifetime also increases.
Purchased at 40 used at 80 - total cost $22,000.
Purchased at 50 used at 80 - total cost $29,320.
Purchased at 60 used at 80 - total cost $50,000.
Comparison of the Cost of LTCI With Partnership Rates
At Age 50 (Preferred Rating)
Age 60 (Standard Rating)
$110 Daily Benefit, 3 -Year Benefit
Plans include Spousal Discount. 30 Day Elimination Period, 5% Compound Inflation Protection
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Annual Premium
Age 100% 80% 50%
50 Years Preferred $839 $801 $753
60 Years Standard $2,050 $1,958 $1,836
Not only is the premium higher at older ages, but it is also likely that the purchaser will no longer qualify for preferred rates at older ages, making the premise increase even more rapidly steep.232
Not only is it less expensive in the beginning, but, even though the person will pay premium payments for a longer period, a policy purchased at a younger age will still be less expensive in the long run.
Issue Age |
Annual Premium |
# of Years Paying Premiums |
Total Premium Paid at age 85 |
50 |
$405 |
35 |
$14,175 |
65 |
$1,086 |
20 |
$20,000 |
79 |
$4,372 |
6 |
$26,232 |
A 79-year old person would pay almost twice the total premium as a 50 year-old, although the 50 year-old paid for more years.
The number of people who can pass underwriting scrutiny reduces drastically as the individual ages, therefore the 79 year-old may not be able to purchase the policy at his age, regardless of premium.
Every 10 years the cost doubles and the number of people who can still qualify for coverage reduces by 50%.
Premiums for LTC Insurance are typically based on the product design, the applicant’s health status, and the prospect’s age. The cost depends primarily on the age of the applicant. The difference is most dramatic from age 40 to age 50, but the older they are the higher the premium will be.
• A 50 year old will pay about half as much as a 60 year old
• A 60 year old will pay almost half as much as a 70 year old
• A 70 year old will pay about one-third as much as an 80 year old for the same insurance policy.
Over 40% Of People Needing LTC Are Under 65!233

If a person “waits” to purchase protection for long-term care, or even do some long-term care planning, several things can happen, none of them good.
The individual’s health will worsen as he gets older. This is not conjecture, this is fact—who are in nursing homes, for instance? Primarily the elderly. It is a very rare situation where an individual’s health gets better the older he gets—the only thing that gets better as it gets older, is wine.
The availability of funds will usually not grow significantly, if the cost of long-term care is a problem. The usual family man will probably have children in college, homes and cars to buy, businesses to run, etc. The hope that “in a little while I will have enough money to afford protection” is a weak response, as times goes by rapidly, and even if the health stays good, when they retire they will be on a fixed income usually—plus the fact that the cost of Long Term Care Insurance expands exponentially with age.
Some may think that the government will take care of them if anything happens. True, if they do not mind losing everything they have worked for and become destitute so that they can participate in a welfare program.
Most people do not want to be a burden for their children and will suffer many indignities to preserve their independence. Not providing for long-term care ups the odds dramatically that the children will be burdened dramatically unless steps are taken so avoid the possibility that they may be a physical and mental burden for their children or other members of their family.
The effects of living longer and out-living assets have been discussed in detail. One of the most crucial factors is the effect of inflation on the cost of long-term care. One of the best indicators is the increase in the cost of nursing homes over the next several years.
The "measuring stick" to project inflation has been 5% as historically in recent years, this is probably as close as one can get without a real crystal ball. Compounded, a dollar increasing five percent will double in 14 years (ergo, if inflation were 10%, the money would double in 7 years). So, for purposes of illustration, the future costs of nursing home care is shown as doubling 14 years and then doubling again in 28 years. The differences are dramatic.

Chapter 2.6. Long-Term Care Insurance
Article 1. Definitions ............................................................10231-10231.8 Article 3.
General Provisions ........................................…………......10232-10233.9 Article 3.
Administration and Enforcement ........………....................10234-10234.7 Article 3.7.
Consumer Protection .............. .............…………….......... 10234.8-10234.97
Article 4. Implementation .....................................................10235-10236.8
Article 5. Inflation Escalator and Benefit Increases ............ 10237-10237.6
SB 1943 (Mello)
Effective January 1993 Long Term Care Insurance:
Chapter 699, Statutes of 1997 Division 2., Part 2., Chapter 2.6 of the CIC:
SB 1052 (Basconcellos), Chapter 699, Statutes of 1997 Division 2, Part 2., Chapter 2.6 of the CIC:
AB 1483 (Gallegos)
Chapter 700, Statutes 1997 - Insurance: long-term care:
SB 527 (Rosenthal)
Chapter 701, Statutes of 1997. Insurance: long-term care:
1998
SB 1537 (Rosenthal) 1998. Long-term care insurance:
1999
SB 870 (Vasconcellos) 1999 Long-term care insurance:
SB 475 (Dunn)
Chapter 669, Statutes of 1999. Long-term care insurance: rate guide: data collection:
2000
SB 898 (Dunn)
Chapter 812, Statutes 2000. Long-term care renewal provisions.
SB 2111 (Dunn)
This bill refines the provisions of SB475 for data collection and consumer rate guide. Due to these changes, the first rate guide was not available until Mid 2001.
2001
SB 455 (Speier)
Effective January 1, 2002, Chapter 328, Statutes 2001, Makes The Following Changes:
2002
SB 1613 (Dunn)
Chapter 675, Statutes of 2002. Long-term care insurance:
SB 1974 (Polanco)
Insurance Policies, Chapter 358, Statutes Of 2002.
SEC.17.25 Section 17213 is added to the Revenue and Taxation Code (see page 165-166)
To summarize the principal affect of HIPAA on Long Term Care Insurance:
Federal Law gives preferential tax treatment to TQ policies.
Some persons will receive a tax deduction for all or part of the premium paid.
All persons will be relieved from the burden of possible income taxes on the benefits.
Qualified Long-Term Care Insurance
Taxpayers can include premiums paid on a qualified long-term care insurance contract for themselves, their spouse, or their dependents when figuring their deduction. But, for each person covered, they can include only the smaller of the following amounts.
The amount paid for that person.
The amount shown below - 2004 rates for year-end age. 241
Age 40 or younger- $260
Age 41 to 50- $490 .
Age 51 to 60- $980
Age 61 to 70- $2,600
Age 71 or older- $3,250
Agents need to do a thorough comparison of a grandfathered contract (one sold before 1/1/97) in the event that it is being replaced with another contract. There may be more favorable benefits, benefit triggers or other features that are not in a proposed contract. The standard of CIC §10235.16(d) regarding material improvement should be kept in mind.
Agents should also direct applicants to get tax advice in the event that a premium increase result in the loss of qualified status for a grandfathered contract, whether or not the contract is being replaced. Treasury has recently ruled that a premium increase does result in a material change to the contract and the loss of favorable tax treatment. That decision could change in the future based on the opposition Treasury receives on that issue, but until then the ruling stands.
When a policy or certificate holder of an insurance contract issued prior to December 31, 1996, requests a material modification to the contract as defined by federal law or regulations, the insurer, prior to approving such a request, shall provide written notice to the policy or certificate holder that the contract change requested may constitute a material modification that jeopardizes the federal tax status of the contract and appropriate tax advice should therefore be sought.234
The 1099 form must be filed by all insurers who pay benefits from an LTC policy, whether tax qualified or not.
This form asks the insurer to indicate whether this policy was tax-qualified or not and whether benefits were paid on a per-diem or reimbursement basis.
If a policy is qualified, and has reimbursement (rather than per-diem) style benefits, nothing further is required of the insured.
However, if the policy is either TQ and per-diem, or NTQ, they must refer to the 8853 form for instructions.
1099 LTC Form & Instructions in Appendix
Tax Form 8853 is used to report the amount of taxable LTC benefits when a policyholder files their tax form. It has instructions regarding reporting both benefits from TQ policies which are per diem benefits above the amount allowed by law and reporting benefits from policies which are not tax-qualified. Please review this form carefully. _
Until there are further clarifications from the US Treasury or the Congress, agents must be very cautious about discussing the tax implications of TQ and non-TQ policies, and should avoid venturing into the profession of being a tax adviser. Agents should recommend that applicants for long-term care insurance seek the advice of a professional tax adviser concerning the differences between TQ and non-TQ policies, how their own circumstances might affect their tax situation, and what tax consequences might result from any contemplated policy changes.
The IRS can be contacted by telephone at (800) TAX-FORM (1-800-829-3676) or on the World Wide (See complete IRS Form 8853 in Appendix) Web at www.irs.gov.
A portion of California’s SB 38 (1996) changed the tax and revenue codes to conform to recently enacted federal law that allows a deduction for medical expenses for the un-reimbursed expenses for qualified (TQ) long-term care services provided to the taxpayer, the taxpayer’s spouse or the taxpayer’s dependents if it exceeds 7.5% of adjusted gross income. Long-term care insurance premiums also must be treated as medical expenses based on a graduated scale based on the individual’s age before the close of the taxable year.
http://www.medicare.gov/NhcomDare/Home.asp
Medicare Helpful Contacts:
http://www.medicare.gov/Contacts/home.asp
Medicare Long-Term Care Info:
http://www.medicare.gov/Nursing/Overview.asp The following are available on the Medicare website:
• Medicare and You 2005
• Medicare MSAs
• Medical Savings Accounts
• Medicare and Women
• Medicare - Guide to Choosing a Medi-gap policy
• Medicare - Guide to Choosing Long Term Care
• Medicare Home Health Compare
STUDY QUESTIONS
1. Insurance companies participating in the California Partnership for Long Term Care (Partnership)
A. are all California-domiciled insurance companies.
B. are specialty companies and not highly rated by the rating bureaus.
C. include only large mutual companies.
D. are all substantial companies, plus include CalPERS.
2. There is hope that the federal government will allow additional states to begin Partnership programs and correct one of the plan’s current weaknesses,
A. the high premiums.
B. elimination of underwriting for individual policies.
C. reciprocity between the states so that an insured from one state would be also insured in another state
D. the addition of more insurers.
3. CalPERS is
A. a large California life insurer who issued LTCI policies on a group basis only.
B. a self-funded employee benefit program.
C. a specialty insurance company who only sells individual LTCI policies.
D. a branch of California Partnership for LTC.
4. CalPERS offers
A. a very limited benefit package.
B. new and innovative benefits, such as portability within the U.S.
C. an investment opportunity for insurance broke houses.
D. plans to nearly everyone with the exception of public employees and retirees.
5. One of the features of CalPERS Partnership Plan is
A. dollar-for-dollar asset protection from Medicaid/Medi-Cal spend down.
B. it is only sold on a group basis.
C. it automatically offers a 7% compound inflation plan.
D. an integrated benefit allowance of $250,000, or $500,000.
6. If an insurance prospect waits to purchase LTCI at age 40 and waits until he is 60, for coverage at age 80, using California Partnership rates,
A. the total cost of coverage would be nearly double.
B. there would be a little difference in the cost, but not enough to make it attractive.
C. the total cost of the coverage would be triple or more.
D. if inflation continues at the present rate, the difference in the total cost would be about $5,000.
7. Of persons receiving long term care presently, nearly half of them are
A. children.
B. employees of large corporations.
C. uninsurable for life insurance.
D. working adults.
8. The major reason why a person should not wait until they are older to purchase LTCI is
A. the person’s health gets worse as they get older.
B. they will probably make more money and won’t need LTCI.
C. the chances that they might need long-term care much higher at younger ages.
D. the way the economy and the war are right now, he may not have enough money to pay higher premiums later.
9. Federal law gives preferential tax treatment to TQ policies and some
A. persons will not receive preferential treatment.
B. has an income that any more tax deductions will throw them into a higher bracket.
C. viatical companies will purchase those policies for the tax advantages.
D. will receive a tax deduction for some or all of the premiums paid.
10. An IRS Form 1099
A. is filed by all insurers who pay benefits from an LTCI policy that is tax qualified.
B. is filed by all insurers who pay benefits from a non-tax qualified LTCI policy.
C. is never filed by an insurer unless specifically required to do so by the IRS.
D. is filed by all insurers who pay benefits from an LTCI policy, whether tax qualified or not.
ANSWERS TO STUDY QUESTIONS
1D 2C 3B 4B 5A 6A 7D 8A 9D 10D