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Home > Long Term Care > Covered Services

Covered Services

Initial Care Planning Visit

You are covered for one initial care planning visit from a care advisor, a long term care professional who can help you explore issues and aid your decision-making. The care advisor helps you:
  • determine what type of care is necessary
  • identify options and resources, including providers, available in your area (but the choice of providers is always yours)
  • develop an ongoing care plan for your consideration.
The plan covers the full cost of the initial visit if you use a designated care advisor. However, if there is no care advisor in your area, the plan also pays the cost of the initial visit to any professional long term care advisor, up to $250.

Nursing Home Care

Benefits are paid toward the cost of care provided in a licensed skilled nursing facility or intermediate care facility, including:
  • room and board
  • custodial care services.
It also includes hospice care services received in an inpatient hospice.

If you are hospitalized while receiving benefits and you are required to pay ongoing room and board charges to guarantee a bed in the nursing home, assisted living facility or hospice facility when you are discharged, the plan will cover those charges for up to 21 days per year.

Assisted Living Facility Services

The plan will pay 100% of the cost, up to the maximum daily benefit shown in the Benefits Schedule for the plan option you have chosen, for the following qualified long term care services provided in an assisted living facility:
  • room and board accommodations
  • nursing care, maintenance or personal care, therapy services, and hospice care provided by a formal caregiver
  • bed reservation charges for up to 21 days per calendar year. The bed reservation shall not exceed the benefit payable if you had been confined in the assisted living facility on that day.

Home Care Services

Sometimes, care can be provided best at home rather than in a nursing home. The plan covers nursing care and custodial care services provided by a licensed:
  • home health care agency
  • nurse
  • adult day care center.
It also includes:
  • care advisory services provided by a licensed care management organization which are received after the initial care planning visit
  • hospice care services received at home
  • homemaker services provided by a licensed home health care agency which include light housekeeping, meal preparation and shopping
  • services provided by a licensed physical therapist, a licensed speech therapist, licensed respiratory therapist, or a licensed occupational therapist through a home health care agency.

Respite Care Services

Respite care includes covered nursing home or home care services which temporarily substitute for regular home services. Up to 21 days per calendar year are covered under the respite care benefit.

Transition Benefit

The plan will pay 100% of the charges incurred, up to $500, for expenses incurred while chronically ill for items that were required to provide qualified services during and after the waiting period. Such expenses may include personal emergency response systems or durable medical equipment. However, the plan will not pay for home modifications that would otherwise qualify as covered expenses if they would increase the value of your home.

Last updated: Thursday April 21 2005
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