What Does Unum Long Term Care Cover: Settings, Limits, and Claims

Unum long-term care insurance covers monthly cash benefits for care in a nursing home, an assisted living facility, or at home when a policyholder can no longer perform basic daily activities on their own or has severe cognitive impairment such as Alzheimer’s disease. The policy also pays for a set of supplemental services like respite care, hospice, adult day care, and in some cases home modifications. As of February 2026, Unum stopped accepting new enrollments in its group long-term care plans, but existing policyholders keep their coverage and continue to receive benefits under their current contracts.¹

What Qualifies You for Benefits

Two separate paths open the door to a Unum claim. The first is a loss of functional capacity: a licensed health care practitioner must certify that you cannot perform at least two of six activities of daily living without hands-on or standby help from another person. Those six activities are bathing, dressing, toileting, transferring in and out of a bed or chair, continence, and eating. The inability must be expected to last at least 90 days.²

The second path is severe cognitive impairment. A physician certifies that you need constant supervision to protect yourself or others because of significant deterioration in short- or long-term memory, orientation to people, places, or time, or deductive and abstract reasoning. Alzheimer’s disease and similar forms of dementia fall under this standard.² Physician certification has to be renewed every 12 months for benefits to continue.³

Care Settings the Policy Pays For

Nursing Homes and Assisted Living

The core benefit is the monthly facility amount, paid when you receive care in a qualifying nursing home or assisted living facility. A nursing facility must be licensed, provide 24-hour nursing care under a physician’s orders, and keep daily medical records. An assisted living facility must house at least ten residents, provide round-the-clock care, serve three meals a day, and keep an awake employee on duty at all times.³⁴⁵

Care at Home

Home care comes in two tiers, and which one you have depends on what you elected at enrollment. The base option, Professional Home and Community Care, covers services from a licensed home health agency or licensed health care professional for at least one hour per day. Eligible services include nursing care, physical, occupational, and speech therapy, homemaker services, hospice care, and adult day care. Adult day care facilities themselves have to run at least five days a week for six hours a day, with a registered nurse on site for at least four of those hours.⁶³

The broader option, Total Choice Home Care (also called Total Home Care), drops the licensing requirement. A family member, friend, or informal caregiver can provide the care and you can still collect the benefit.⁵⁶ This option carries a higher premium.

Home care benefits are paid as a percentage of the facility amount. Depending on the plan, that percentage ranges from 50% to 75%, and some plans pay at 100%.⁷⁴

Supplemental Services

Beyond the core facility and home care benefits, Unum policies also cover:

Respite care to give an informal caregiver a break, available up to 15 days per calendar year and paid at one-thirtieth of the home care monthly benefit per day.⁷
Bed reservation, which holds a spot in a nursing or assisted living facility for up to 15 days per calendar year during a temporary absence.⁸
Hospice care, covered as part of the home and community care benefit.⁸
Caregiver training, medical alert devices, durable medical equipment, and home modifications for wheelchair access, under some plans.⁹

Alternate Care Plans

If the standard covered services don’t fit your situation, the policy allows Unum to agree to an alternate care plan. This might include rehabilitation, home modifications, or medical equipment the contract doesn’t otherwise list. The alternate plan has to be medically necessary, prescribed by a physician, and agreed to in writing by you, your provider, and Unum. It’s voluntary; if you decline, standard benefits continue.¹⁰³

How Much the Policy Pays

You chose the monthly facility amount at enrollment. Under common plan designs, that amount ranges from $2,000 to $9,000 per month in $1,000 increments. Amounts up to $6,000 were often available on a guarantee-issue basis for employees, with no medical questions asked. Anything above that required medical underwriting.⁴

Benefit duration is typically three years, six years, or lifetime. The lifetime maximum equals your monthly facility amount multiplied by 12, then by the number of years. A $3,000 monthly benefit on a three-year duration gives you a $108,000 pool.⁴ A lifetime duration has no fixed dollar cap.

The Waiting Period Before Benefits Start

Before Unum pays anything, you have to satisfy an elimination period. The standard is 90 days.⁴ For periods longer than 30 days, the days don’t need to run consecutively; they can be accumulated over as much as 730 days. You only have to satisfy the elimination period once in your lifetime. If a new episode of disability starts within six months of a prior one, it counts as the same loss and doesn’t reset the clock.³

For facility care, the accumulation window is three times the elimination period, so 270 days for a 90-day period. For professional home care under older policy forms, the period may be shorter (20 or 30 consecutive days), and each calendar week with at least one day of home care counts as a full seven days toward the requirement.³

Inflation Protection

Because care costs rise, Unum offers optional inflation riders. The most common is 5% compound inflation with no cap: the monthly benefit grows each year by 5% of whatever it was at the start of that year, and premiums don’t go up as a result of these automatic increases.⁶ A $2,000 monthly benefit would grow to roughly $5,307 after 20 years under this rider.²

The simpler alternative is 5% simple benefit increase, which adds 5% of the original amount each year rather than compounding. If you later drop the rider, you keep the accumulated benefit amount at your original age-rated premium.⁶

What Is Not Covered

Unum policies will not pay benefits for a disability caused by:

War or acts of war, declared or undeclared.
Intentionally self-inflicted injuries or attempted suicide.
Criminal acts for which you’ve been convicted under state or federal law.
Substance abuse, including alcoholism and voluntary use of controlled substances not prescribed by a physician.
Psychiatric or psychological conditions such as depression, anxiety, personality disorders, and schizophrenia. Alzheimer’s disease and other irreversible dementias are carved out of this exclusion and remain covered.¹⁰
Time spent outside the United States, its territories, or possessions for more than 30 consecutive days. Some policy forms include an international benefit provision that pays on an indemnity basis if you become chronically ill while traveling abroad, provided you selected a home care benefit.⁶
Hospital confinement, unless the nursing facility is a distinctly separate part of a hospital.¹¹

Pre-Existing Conditions

For coverage that didn’t require medical underwriting, such as guarantee-issue enrollment during an open window, Unum applies a pre-existing condition exclusion. A pre-existing condition is anything you received treatment, consultation, diagnostic services, or prescription drugs for during the six months before coverage began. If a disability caused by that condition starts within the first six months of coverage, Unum will not pay.¹⁰⁷ Some older policy forms that required full medical underwriting didn’t carry a pre-existing condition exclusion.³

Premiums While You’re on Claim

Once you’ve satisfied the elimination period and benefits become payable, Unum waives premium payments for as long as the disability continues. Premiums you paid during the elimination period are refunded on a prorated basis. If you recover and benefits stop, premium payments start again.³ One exception: premiums are not waived while you are receiving only respite care benefits.¹⁰

If you stop paying premiums and the policy lapses, nonforfeiture protections may preserve some value. Unum policies include a shortened benefit period option that provides a reduced pool of benefits based on premiums already paid. There’s also a contingent nonforfeiture benefit that activates if Unum raises premiums substantially. The trigger threshold depends on your issue age, ranging from a 200% increase at age 29 or younger down to a 10% increase at age 90 or older.³

How to File a Claim

You can start a claim as soon as you experience a loss of functional capacity or cognitive impairment. You don’t have to wait for the elimination period to run. Call Unum’s LTC Benefit Center at 1-800-693-4988 or download a claim form from unum.com.¹²¹³

Required paperwork includes a completed individual statement, a HIPAA authorization that lets Unum pull your medical records, and an attending physician statement from a licensed health care practitioner. Unum acknowledges receipt within three business days and assigns a benefits specialist. The review may include a phone interview and sometimes a face-to-face functional assessment by an independent medical professional. From the time Unum has a completed claim in hand, the average decision takes four to six weeks.¹³

If You Leave Your Job or Have Spouse Coverage

Most Unum long-term care policies are group coverage offered through an employer. Under the portability provision, if your employer ends the group policy or you separate from the job, you can elect to continue the same coverage on a direct-bill basis. The election has to be made within 31 days of the date group coverage would otherwise end. Retirees and anyone already on direct billing transfer to portable coverage automatically.⁷ At that point you pay the full cost of coverage yourself.¹⁴

Many Unum group plans let employees enroll a spouse or domestic partner, though eligibility depends on the specific employer contract. Spouse and partner applications are generally subject to full medical underwriting and don’t qualify for guarantee-issue enrollment. If the employee dies, the surviving spouse can continue existing coverage. In a divorce, a former spouse may port or continue their own coverage within the timeframe set in the contract.¹⁵

A Note on Premium Increases

Long-term care premiums are not guaranteed level forever. Unum has sought significant rate increases on in-force policies. In Oregon, the state Division of Financial Regulation approved a Unum increase ranging from 50% to 150% on a block of more than 13,000 policies; only policies with inflation protection riders were affected. If you face a premium hike, you can usually mitigate it by reducing your monthly benefit, shortening the benefit period, dropping optional riders, or lengthening the elimination period.¹⁶ If the increase is large enough to trigger the contingent nonforfeiture benefit, dropping the policy leaves you with a shortened benefit based on premiums already paid.

1
WSHA. The Long-Term Care Shake-Up: What Unum’s Exit Really Signals for 2026
2
Unum. Long Term Care Unum Enrollment Kit
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SEC. UnumProvident Advantage I Policy Form LTC94Q
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Workday Benefits. Unum Long-Term Care Plan Highlights and Schedule of Benefits
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FBMC Benefits. Long-Term Care Protection
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Multnomah County. Unum Optional Long Term Care Plan Booklet
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DMUSD. GLTC Kit – Policy 105237
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Pennsylvania Insurance Department. Unum Group Long Term Care Policy Information
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MCPS. LTC Info and Application
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SAIF Corporation. Unum Long Term Care Insurance Certificate
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Dane County. LTC Benefits Summary
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Multnomah County. Optional Long-Term Care Insurance
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Multnomah County. Long Term Care Brochure FAQ
14
LSU. Unum LTC Portability Form
15
Unum. Plan Administration Guide
16
Oregon Division of Financial Regulation. Rate Increases