Care Coordinator Benefit. We will pay the services for Care Coordination by a Care Coordinator who is employed by a Care Coordination Provider Agency or is the Qualified Official Designee of a Care Coordination Provider Agency to provide Care Coordination. The California Department of Health Services must approve the Care Coordination Provider Agency. The Elimination Period does not apply to the Care Coordinator Benefit. Any benefits We pay the Care Coordinator do not count against Your Policy Lifetime Maximum Benefit. You must, however, satisfy the applicable Elimination Period before We will pay benefits for any care or services the Care Coordinator coordinates, and the benefits We pay will count against the Policy Lifetime Maximum Benefit as provided in each Benefit.
Care Coordinator Benefit. We will pay the Care Coordinator’s charges to prescribe a Plan of Care for You, if You request the Care Coordinator Benefit. We will pay the charges for the Care Coordinator, except if You elect to provide Us with a Plan of Care from a Licensed Health Care Practitioner instead of the Care Coordinator, We will evaluate Your claim and pay benefits in accordance with the Policy’s provisions.
(a) While You are following the Plan of Care prescribed for You by the Care Coordinator, We will also pay:
(i) The charges of the Care Coordinator to determine if You remain a Chronically Ill Individual and to prescribe a current Plan of Care for You at least annually; and
(ii) The Care Coordinator’s charges to coordinate the services You receive under Your Plan of Care. You do not have to meet the Elimination Period to use the Care Coordinator, and the amounts We pay the Care Coordinator do not count against Your Policy Lifetime Maximum Benefit. You must, however, satisfy the applicable Elimination Period before We will pay benefits for any care or services the Care Coordinator coordinates, and the benefits We pay will count against the Policy Lifetime Maximum Benefit as provided in each Benefit.
(b) Advantages of Using the Care Coordinator. While You are following the Plan of Care prescribed by the Care Coordinator, We will also enhance Your Home and Community-Based Care Benefit as follows: (This benefit is not available in the Nursing Facility and Residential Care Facility Only Insurance Policy.)
(i) We will reduce the Elimination Period that must be satisfied before the Home and Community-Based Care benefits are payable to 20 days of service. The full Elimination Period must be satisfied before benefits other than Home and Community-Based Care are payable.
(ii) We will determine Your Home and Community-Based Care benefits on a monthly, rather than a daily basis. This means that We will pay the Eligible Charges You incur for Home and Community-Based Care benefits in any calendar month, up to 31 times the Home and Community Based Care Maximum Daily Benefit shown on the Schedule of Benefits of the Policy.
(iii) We will pay a benefit for each day on which You receive at least four (4) hours of Informal Care (which will not be paid when provided by a Family Member who lives in Your home or residence) and on which no other covered services are provided. We will pay:
1. An Informal Care daily indemnity benefit of 50% of the Home and Community-Based Care Maximum Benefit; up t...
Care Coordinator Benefit. We will pay the services for Care Coordination by a Care Coordinator who is employed by a Care Coordination Provider Agency or is the Qualified Official Designee of a Care Coordination Provider Agency to provide Care Coordination. The California Department of Health Services must approve the Care Coordination Provider Agency. Since Care Coordination is included in this Policy We will reduce the Elimination Period that must be satisfied before the Home and Community-Based Care benefits are payable to 30 days of service, even if a longer Elimination Period was selected. The remaining Elimination Period, if any, must be satisfied before benefits other than Home and Community-Based Care are payable. The Elimination Period does not apply to the Care Coordinator Benefit. Any benefits We pay the Care Coordinator do not count against Your Policy Lifetime Maximum Benefit. You must, however, satisfy the applicable Elimination Period before We will pay benefits for any care or services the Care Coordinator coordinates, and the benefits We pay will count against the Policy Lifetime Maximum Benefit as provided in each Benefit.
