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Training MaterialsBasic Features and Benefits Contingent Benefits Upon Lapse– Contingent Nonforfeiture goes into effect if thepolicy lapses within a 120120-dayday period following thedue date of a substantially increased premiumaccording to a schedule that varies with theins red’s ageinsured’sage. The insuredins red mayma also elect toreduce benefits– No longer a Rider, included in base policy24

Training MaterialsBenefit Increase Riders/Options 5% Compound Inflation Protection– DBA will automatically increase annually by 5% of thecurrent DBA with NO corresponding increase to thepremium– The balance of the Total Lifetime Benefit (TLB) amount willautomatically increase annually based on the increase in theDBA.DBA– Increases continue when benefits are being paid25

Training MaterialsBenefit Increase Riders/Options (continued) 5% Simple Inflation Protection– DBA will automatically increase annually by 5% of theoriginal DBA with NO corresponding increase to thepremiumi– The balance of the Total Lifetime Benefit (TLB) willautomatically increase annually based on the increase in theDBA.DBA– Increases continue when benefits are being paid26

Training MaterialsBenefit Increase Riders/Options (continued) Future Purchase Option (FPO)– DBA and balance of lifetime benefit automatically increase by5% annually unless the client rejects the increase– Cost of the “increase” in coverage will be based on theinsured’s attained age and premium rates at the time theincreasec ease tatakeses eeffectect– Rejection of an increase two times in a row stops any futureautomatic increases unless the client asks to have themreinstated– Increases are not available if the insured is benefit eligible No Inflation Protection– The DBA and TLB remains the same throughout the lifetimeof the policy27

Training MaterialsOptional Riders Nonforfeiture Rider ((All Policies))– If policy and rider premiums have been paid for at least 3policy years and for any reason the insured stops payingpremiums (lapses) or sends a written request to cancel thepolicy, a reduced Total Lifetime Benefit (TLB) will beavailable Reduced TLB will be the greater of:– 30 times either the Nursing Home Maximum DBA orFacility DBA (which ever is shown on page 3 of the policy,in effect immediately prior to the Nonforfeiture Date) or– The sum of all premiums paid or waived under the terms ofthe policy– The total benefit available will not be more than theremaining TLB when policy lapsed Additional premium for this rider is 12% of base rate28

Training MaterialsOptional Riders O tiOptionall IndemnityI dit RiderRid (V(Valuel PPolicyli OOnly)l )– Must be purchased at time of application Pays the full DBA every day that a primary service isreceived, regardless of cost of that service Allows the insured to have more flexibilityy in their care Combines an affordable policy with control of benefitdollars that appeals to a segment of the market No coordination of MetLife Coverage or Medicarerequired No assignment of benefits29

Training MaterialsOptional Riders Return of Premium Rider (All Policies)– Provides for a return of premium at Insured’s death Amount of ppremium returned is total ppremium ppaid lessbenefits paid or payable by MetLife Premium returned is paid to the Estate of the Insured or adesignated beneficiary Must be purchased at initial application Rider must be in effect for 10 years Additional premium for this rider is 23% to 58% of baserate depending on age There may be tax consequences for the Insured’s estatewhen the LTCI premiums are returned - client shouldcheck with a tax advisor30

Training MaterialsOptional Riders Calendar Day Rider*Rider (Value and IdealPolicies only) Once Chronically IllIll, Home and Community Care EliminationPeriod Changes from Days of Service to Calendar Days 50 times NH DBA for supplemental items, i.e., durable medicalequipment certain home modificationsequipment,modifications, personal emergencyresponse systems - Do not need to satisfy EP and paymentreduces Total Lifetime Benefit Rider must be purchased at initial application Cannot be purchased with Home Care Elimination PeriodWaiver Additional premium is 7% of base rate*Replaces Home Care Plus Rider31

Training MaterialsOptional Riders Home Care Elimination Period Waiver(Value and Ideal Policies only) Waives the EP for home and community basedcare, once the insured is chronically ill– Days that Home and Community Care are received count towardsatisfying the Facility Care EPEP.– Pays a maximum lifetime benefit amount up to 50 times NH DBAfor supplemental items such as durable medical equipment,certaint i homehmodifications,difi tipersonall response systemst- DoD nottneed to satisfy EP and payment reduces Total Lifetime Benefit– Rider must be purchased at initial application– Cannot be purchased with Calendar Day Rider– Additional Premium is 17% of base rate32

Training MaterialsOptional Riders Shared Care Rider ((All Policies)) Allows spouses/domestic partners* to utilize eachother’s benefit pool– WhWhen theth firstfi t spouse/domestic/dti partnertdepletesd l t hihis/her/h TTotalt lLifetime Benefit , he/she can tap into the second spouse’s/domestic partner’s Total Lifetime Benefit– If insuredid spouse/domestic/dti partnertdies,diththe remainingi i TTotalt lLifetime Benefit, if any, from the deceased insuredspouse’s/domestic partner’s policy will be added to theremaining Total Lifetime Benefit under the living insuredspouse’s/domestic partner’s policy– Spouses/domestic partners must have identical Policy benefits– CanC bbe purchasedhd att any time,tisubjectbj t tot UnderwritingU diti*Not applicable in VA33

Training MaterialsOptional Riders Sh d CareSharedCRidRider ((continued)tid)– Both can utilize same Total Lifetime Benefit– Rider not available with Unlimited Benefit Period or withRestoration of Benefits Rider– Waiver of premium only for spouse/domestic partner onclaim– Future Purchase Option Increases available only for nonclaim spouse/domestic partner– Both spouses/domestic partners may be on claim at thesame time– Additional premium is 6% to 32% of base rate depending onBenefit Period selected34

Training MaterialsOptional Riders Survivorship Rider (All Policies) Provides financial relief for a survivingSpouse/Domestic Partner*Partner when the otherSpouse/Domestic Partner dies– Rider Must be in effect for 10 years without any benefits paid orpayable– Surviving spouse/domestic partner will be entitled to a paid-uppolicypy if the other one dies– Can be purchased at any time, subject to underwriting– Identical coverage is not required– Additional premium is 9% of base rate*Not applicable in VA35

Training MaterialsOptional Riders Restoration of Benefits Rider Restores all or part of the Total Lifetime Benefits if: ThThe insuredid receivesibenefits,bfit ththen recovers andd iis nottchronically ill for 180 days, and The Total Lifetime Benefit was not exhausted– Must be purchased at time of initial application The EP does NOT have to be satisfied again when theinsured goes back on claim in the future! Additional premium is 2% to 8% based on the BenefitPeriod selected Not available with Premier policypolicy, Shared Care Rideror Unlimited Benefit duration36

Training MaterialsValue Policy Features and Benefits The Value Policyy includes the followingg features:– Daily Reimbursement– Nursing Home/In-patient Hospice up to 100% of DBA– Home Care/Adult Day Care choice of 100%, 75% or 50% ofDBA– Assisted Livingg same as selected for Home Care DBA– Elimination Period Days of Service– Caregiver Training– Bed Reservation– Respite Care 21 days per policy year– International Coverage– Optional Indemnity Rider37

Training MaterialsValue Policy Features and Benefits(continued) The following are not available with the ValueP liPolicy:– Transition Expense Allowance– Supportive Services/Specialized Transportation38

Training MaterialsIdeal Policy Features and Benefits The Ideal Policy includes the following features:– Monthlyy Reimbursement– Nursing Home / Assisted Living / In-patientHospice up to 100% of DBA– Home Care / Adult Day Care choice of 100%, 75%or 50% of DBA– Elimination Period Days of Service39

Training MaterialsIdeal Policy Features and Benefits((continued)tid) The Ideal Policy includes the following features(Continued):– Caregiver Training– RespiteRit CCare 21 ddays per policyli year– Bed Reservation– International Coverage– Transition Expense Allowance– Supportive Services/Specialized Transportation40

Training MaterialsIdeal Policy Features and Benefits((continued)tid) The following is not available with the Ideal Policy:– Indemnity Rider41

Training MaterialsPremier Policy Features and Benefits The Premier Policy includes the following features:– Cash Payment / Per Diem Benefit – Paid out on adaily basis– No proof of Covered Services (no bills) requiredfor Basic Benefit claims– Nursing Home / Assisted Living Facility / In-PatientHospice 100% DBA (pays full DBA regardless ofcost of services; proof of confinement required inorder to establish proper DBA)42

Training MaterialsPremier Policy Features and Benefits(C ti(Continued)d) The Premier Policy includes the following features(continued):– Basic Benefit (non-Facility) choice of 100%, 75%or 50% of DBA– Elimination Period Calendar Days– Bed Reservation– International Coverage43

Training MaterialsPremier Policy Features and Benefits(Continued) The following features are not applicable (becausethe client can choose how to use his/her benefitdollars, these options are not necessary in the PremierPolicy):– RespiteRit CCare– Caregiver Training– TransitionTiti EExpense AllAllowance– Alternate Service Benefit– SupportiveSti SServicesi/SSpecializedi li d TTransportationt ti– Coordination of Benefits44

Training MaterialsPremier Policy Features and Benefits(Continued) The following features are not available with thePPremieri Policy:P li– Unlimited Benefit– Optional Indemnity Rider– Optional Restoration of Benefits Rider– Optional Calendar Day Rider– Optional Home Care Elimination Period WaiverRider45

Training MaterialsFacilities-Only Policy Features and Benefits The Facilities-OnlyFacilities Only Policy includes the followingfeatures:– Monthlyy Reimbursement upp to amount of coveredservice, not to exceed DBA times days in the month– Nursing Home / Assisted Living Facility / In-patientHHospicei up tto 100% off DBA– Elimination Period Days of Service– TransitionTiti ExpenseEAllAllowance– Caregiver Training– InternationalI ttil CoverageC46

Training MaterialsFacilities-Only Policy Features andBBenefitsfit (continued)(tid) Because this Policy only offers coverage in af ilit thefacility,th followingf ll i featuresf td nott apply:dol– Home Health Care– AdultAd lt DDay CCare– Respite Care– SupportiveSti SServicesi/SSpecializedi li d TTransportationt ti– Optional Indemnity Rider– OptionalO til CalendarC l d DDay RidRider– Optional Home Care Elimination Period Waiver47

Training MaterialsVIP2 Premium Discounts– 30% Spousal (both must apply and be approved) Domestic Partners eligible where permitted by law *– 15% MaritalM it l (both(b th ddo nott hhave tto apply)l ) Domestic Partners eligible where permitted by law*– 15% Residential (2 or more people living togetherwho apply and are approved, e.g., siblings, friends,couples not defined as domestic partners)– 10% Preferred Health– 5% or 10% Multi-Life Discounts– Discounts are additive*Not applicable in LA and VA48

Training MaterialsVIP2 Premium Payment Riders MMustt choosehatt initiali iti l application,li tiandd nott availableil blwith Future Purchase Option– 10 Year Premium Paymenty(p(paid-upp after 10 yyears))– Paid Up Premiums Rider (paid up at age 65 – minimum 10years)– Double Pay First year (reduced premium in 2nd year andthereafter)– Reduced Pay at age 65 (higher premiums prior to age 65 –premium reduced by 50% on or after policy anniversary atage 65)Note: Choosing any of the payment options other than regular pay mayimpact the tax deductibility of the premium. The client should consult a taxadvisor for further clarification.49

Training MaterialsPremiums Waived on Claim Once the insured is receiving payment of benefits.50

Training MaterialsPolicy Effective Dates Cash with application– Conditional Coverage as of date application signed– Policy effective date will be date when the lastunderwriting/forms requirement is met– If claiml i iis iincurreddbbetweentapplicationli ti signi ddatet anddddatet llasttrequirement is received, policy effective date will be changed toapplication sign date No cash with application– No Conditional Coverage– Policy effective date is 28 days after last underwriting/formsrequirement is met51

Training MaterialsPolicy Delivery Requirements To be in compliance with the HIPAA requirements, iti criticalisiti l ththatt policiesli i bbe ddeliveredlid withinithi 30 ddays offapproval and that a record of that delivery is on file– Deliver the LTCI policy within 30 days from the policyapproval date– Have the insured sign the Policy Delivery Receipt (PDR)– Any changes made to the policy at delivery should berecorded on page 2 of the PDR52

Training Materials30-Day30Day Free Look Period Once you deliver and review the policy with theiinsuredd ththey hhave 30 ddays tto reviewiit andd makek anychanges to their coverage or return it for a full refund Any requests for changes at this time should bemade in writing and signed by the insured Any changes after this time frame may require a newapplication and underwriting53

Training MaterialsCoordination of Benefits If a client has more than one MetLife Individual LTCpolicyli or a MMetLifetLif LTC GGroup certificate,tifi t ththe claimsl ipayable will be coordinated– The benefit amount ppayableywill be reduced so that thecombination of all policies will not exceed 100% of the costof covered services Not applicable with the Premier Policy or when Indemnity Rideris added to Value Plan The policy or certificate with the earliest issue date will bedeemed the primaryy coverageg Reimbursement Policies must follow HIPAA requirementsregarding Medicare54

Training MaterialsPolicy Limitations and Exclusions What’s not covered under the Value, Ideal andF iliti O l PoliciesFacilities-OnlyP li i 1:– No payment will be made for any of the following:1 T1.Treatmenttt off alcoholisml h lior ddrug addiction,ddi tiunlesslththe addictionddi tiwas due to such drug (s) taken on the advice of a physician2. Any care received while in a hospital, except in a unitspecifically designated as a Nursing Home or Hospice Facility3. Any injury or sickness that results from (a) any war, or act ofwar (whether declared or undeclared); or (b) participation in ay, riot or insurrectionfelony,1Ridersmay contain limitations55

Training MaterialsPolicy Limitations and Exclusions((continued)tid) What’s not covered under the Value, Ideal andF iliti O l PoliciesFacilities-OnlyP li i (continued):(tid)4. Any intentionally self-inflicted injury5 Services5.Services, other than supportive services2, performed bya member of the insured’s immediate family6. Any care or services received outside the United Statesor its territories except as described in the InternationalCoverage Section of the policy2 ForValue and Facilities-Only Policies, the exclusion is as follows:Services performed by a member of your immediate family.56

Training MaterialsPolicy Limitations and Exclusions(continued) What’s not covered under the Value, Ideal andF iliti O l PoliciesFacilities-OnlyP li i (continued):(tid)7. Any service or supply to the extent the expense for it isreimbursable under Medicare, or would be reimbursablebut for the application of a deductible, coinsurance or copayment amount. This exclusion will not apply whereMedicare is the secondary payer under applicable law.8. Treatment received in a government facility (unlessotherwise required by law): services for which benefitsare available under a government program (exceptMedicaid); or services for which no charge is normallymade in the absence of insurance.57

Training MaterialsPolicy Limitations and Exclusions(continued) What’s not covered under the Premier Policy:– No payment will be made for any of the following:1. Any injury or sickness that results from: (a) any war, oractt off war (whether( h th declaredd l d or undeclared);d l d) or (b)participation in a felony, riot or insurrection2. Any intentionally self-inflicted injury58

Training MaterialsPolicy Limitations and Exclusions((continued)tid) For all plans, these exclusions may not apply in allstatest t andd may vary dependingddi on ththe statet t iin whichhi hthe client lives at the time of policy issue or the planthat is selected The policy that the insured receives will contain theexact exclusions for the resident state If the insured moves to another state, the stateguidelines where the policy was originally issued willapply59

Training MaterialsImportant InformationLike most long-term care insurance policies,MetLife’s policies contain certain exclusions,li it tilimitations,waitingiti periods,i d reductionsd tioff benefitsbfitand terms for keeping them in force.P li FPolicyFeaturestanddBBenefitsfit MMay VVary BBy StStatet60

computed on a daily basis, for covered services the insured receives Example: If an insured has a Value Policy with a 100 DBA, he/she will be reimbursed up to 100 a day for covered long-term care services. If the covered services on Monday cost 50 he/she will be reimbursed 50 Ifcovered services on Monday cost 50, he/she will be reimbursed 50.