These are activities you need to perform to take care of yourself on a day-to-day basis. They include bathing, continence, dressing, eating, toileting and transferring. To receive benefits under the plan, a licensed healthcare practitioner must certify that you are expected to be unable to perform (for at least 90 days) two or more activities of daily living or that you have a cognitive impairment that requires substantial supervision or assistance from another person.
Adult day care
A care option for people who cannot stay alone, need a protective setting and like to be with people. Adult day care centers are not residential facilities but offer services for up to 12 hours a day. Services include personal care, socialization, group activities and, in some cases, medical care such as medication supervision.
Assisted living facility care
Long Term Care Services provided by a state licensed living arrangement in a facility for individuals whose condition precludes total independent living, but which does not require the level of care available in a Nursing Home or similar setting.
Care coordination is a feature of your long-term care plan. There are a wide variety of long-term care options available so you might find it useful to have a qualified professional help you and your family understand your choices. Care coordinators are ready to help maximize benefits while accommodating individual differences, needs and personal preferences. After an initial assessment, we design an individual plan of care specifically for your needs. If you wish, your care coordinator will identify and help select appropriate care providers, negotiate charges, and monitor the care plan. A qualified healthcare professional who can help you and your family maximize long-term care benefits and explore alternative care options. (see the definition of Care Coordination above)
Caregiver Training Benefit
Pays benefits for training an unpaid caregiver. For example, a physical therapist might teach your caregiver how to lift and transfer you safely.
To receive benefits from your group long-term care plan, you must be chronically ill. That means you are certified by a licensed healthcare practitioner as being unable to perform (without substantial assistance from another individual) at least two activities of daily living for a period of 90 days or to need substantial supervision to protect you from threats to health and safety due to a cognitive impairment. Cognitive impairment is deterioration in your ability to remember, think or reason that has been diagnosed by a licensed healthcare practitioner and necessitates that you must have substantial supervision because your behavior could pose a health or safety hazard to yourself or to others.
Long-term care services delivered outside of a nursing home such as home care, home hospice care, adult day care, or caregiver training.
Community-Based Care Benefit
This refers to the maximum daily, weekly, or monthly amount paid for home-based care such as home care, adult day care, and home hospice care.
Daily Nursing Home Care Benefit
Refers to the daily amount your plan will pay for services in a nursing home or similar facility. It is the maximum amount your plan will pay on a single day. Other benefits in your plan may have their own limits based on a percentage of the Daily Nursing Home Benefit.
Hospice care offers relief and support for the terminally ill and their families. Hospice care facilities are often more home-like than hospitals or nursing homes, but offer medical care and attention. Hospice care can also be provided in your home.
The Daily Maximum Benefit you elect today may not cover the cost of long-term care many years from now when you need it. That is why every plan has a way to help keep up with inflation. You'll be given future opportunities to purchase additional coverage to protect yourself against rising costs. In some plans, you may have other options that automatically increase your coverage each year.
Your Lifetime Maximum Benefit is the total amount you can receive in benefits. It is the total pool of money available to you to pay for long-term care services.Many people receiving long-term care benefits get services in a home-based setting rather than in a facility, so their daily charges may be lower than the Daily Maximum Benefit. Unused daily benefits remain available for another day, so your coverage lasts as long as you need it, until you reach your plan’s Lifetime Maximum Benefit.
Services for people unable to care for themselves; may include assistance in the home or adult day care center with nursing or personal care activities or confinement in an assisted-living facility or nursing home. Most providers of long-term care services must be licensed or certified by the state.
These state licensed residential facilities offer a wide range of services, including care from licensed health professionals that are matched to residents' needs.
Plan of care
A program of treatment or care designed with your input by a licensed healthcare practitioner. By law, a plan of care must be in place for you to receive benefits from your group long-term care plan.
Residential care facility
A residential care facility is a facility licensed as a Residential Care Facility for the Elderly as defined in California Health and Safety Code § 1569 or under an equivalent licensing requirement in the state in which it is located. If you reside outside of California, the Residential Care Facility benefit will be paid for residents in an Adult Foster Home which is a residential alternative to a Nursing Home for people whose condition is such that they cannot live alone, but whose needs can be met in a private home. An Adult Foster Home must be certified or licensed by the state in which it is located.
Respite Care is the temporary use of paid long-term care services to relieve family members and other informal caregivers of their duties so they can take needed time off.
Skilled nursing facility
This facility provides the highest level of medical care from licensed health professionals. Emphasis is placed on patients’ medical care, but other care is available, including physical and occupational therapy. These facilities must be licensed by the state.
Waiting Period/Elimination Period
The period of time you must wait before benefits begin. The waiting period is based on calendar days. It is the specified number of days beginning at the point you become chronically ill. You do not have to receive long-term care services in order for a day to count. There is typically a 90-day deductible for State of Alaska plans.
Waiver of premium
This means that you will not have to pay premiums while you are receiving benefits from the plan. You never have to pay those premiums back.
Home Health Care
Custodial Home or community-based care includes care in your residence provided by a home health agency that sends a qualified home healthcare provider to provide nursing care, personal care, nutritional services, meal preparation or physical therapy.