Qualifying for Benefits

When am I eligible for benefits under the plan?

  • You need help with at least two "activities of daily living" and will likely need it for at least 90 days, OR
  • You are diagnosed with a cognitive impairment that requires supervision AND
  • a medically licensed healthcare professional certifies that your condition qualifies you.

The Activities of Daily Living are: eating, dressing, continence, transferring, bathing and toileting.

In addition, the elimination period must be satisfied, and you must be receiving covered services under a plan of care.

I understand that once I'm eligible for benefits, there is a 90 day elimination period, similar to a deductible I may have on other insurance. Please explain.

Once you are eligible for benefits, a "waiting period" of 90 calendar days starts on the first day you receive care and extends for 90 calendar days while you remain chronically ill. You are not required to receive services during these 90 days. Once the elimination period is satisfied, benefits for covered services become payable.

Once I have a need for long term care and start drawing the benefit, do I still continue to pay premiums?

No. Premium payments are waived while you are receiving benefits under the Nursing Facility or Assisted Living Facility Benefit, Bed Reservation Benefit, Home and Community Care Benefit or Hospice Care Benefit.