UNDERSTANDING YOUR "ALTERNATIVE PLAN OF CARE" BENEFIT
Your Alternative Plan of Care benefit is an important policy benefit that can provide you with the resources you need to pay for types of care other than nursing home confinement. Alternative Care could include home health care, adult day care, respite care, hospice services, different sites of care, and modifications to your mobility needs.
However, it is important that you understand the following requirements regarding the Alternative Plan of Care benefit:
- The Alternative Plan of Care must be initiated by you, written by your Physician and submitted to us for pre-approval prior to your receipt of any form of Alternative Care.
- We will not pay benefits for any type of Alternative Care unless we are first reasonably satisfied that you would otherwise require nursing home confinement. To help us in this determination we generally employ a Case Management Agency. A Case Management Agency is an entity qualified to perform an independent assessment to determine whether your inability to perform Activities of Daily Living, or Cognitive Impairment, is such that nursing home confinement would be warranted, based on existing standards of medical practice, in the absence of the Alternative Care. For example, we will not agree to Alternative Care benefits if you require such care for only a few hours per day or if the level of care you require is such that an ordinarily prudent person would not consider nursing home confinement a viable or realistic option.
- In addition, we must agree to the type of care and the amount of benefit we will pay. Typically, the amount payable will be less under the Alternative Plan of Care than the policy benefit for nursing home confinement.
- All Alternate Care benefits will be paid pursuant to a written agreement which will describe the type of care, the amount of benefits, the time period for which benefits will be payable and the extent to which the benefits will offset those otherwise payable under your policy.
It is important to note that you have not been charged any additional premium for this benefit. It is for this reason that the Alternate Plan of Care benefit is intended to be paid only if we would have otherwise paid the nursing home benefit under the policy.
The foregoing requirements are more restrictive than if you were to purchase specific coverage to provide, for example, home health care benefits. Under specific home health care coverage you do not have to first demonstrate the need for nursing home care in order to receive home health care benefits. If you prefer this more liberal coverage for home health care please contact your agent or our Administrative Office for further information.
Administrative Office
P.O. Box 64913
St. Paul, MN 55164
NOTE: This is a re-issue of an informational document corresponding with the Rider form series ATL-APC.