Common use of How to Qualify for Benefits Clause in Contracts

How to Qualify for Benefits. You will be eligible for benefits provided by the Policy during any period when You are determined to be a Chronically Ill Individual and You are receiving Qualified Long-Term Care Services prescribed for You in a written Plan of Care. You will be considered a Chronically Ill Individual when You meet one of the following criteria: (a) You are not able to perform, without Standby Assistance or Hands-on Assistance from another individual, 2 or more of the following 6 Activities of Daily Living: Bathing, Dressing, Eating, Continence, Toileting and Transferring due to loss of functional capacity and Your loss of functional capacity is expected to last at least 90 days; or (b) You have suffered a Severe Cognitive Impairment requiring Substantial Supervision to protect You from threats to health and safety. (c) You must also: (i) Have been certified, within the past 12 months, as a Chronically Ill Individual by a Licensed Health Care Practitioner; and (ii) Have a written Plan of Care that prescribes the types of care, services and supplies for which You claim benefits. The Licensed Health Care Practitioner must be employee of the Care Coordination Provider Agency or an Official Designee of a Care Coordination Provider Agency to prescribe the Plan of Care and certify You as a Chronically Ill Individual.

How to Qualify for Benefits. You will be eligible for benefits provided by the Policy during any period when You are determined to be a Chronically Ill Individual and You are receiving Qualified Long-Term Care Services prescribed for You in a written Plan of Care. You will be considered a Chronically Ill Individual when You meet one of the following criteria: (a) You are not able to perform, without Standby Assistance or Hands-on Assistance from another individual, 2 or more of the following 6 Activities of Daily Living: Bathing, Dressing, Eating, Continence, Toileting and Transferring due to loss of functional capacity and Your loss of functional capacity is expected to last at least 90 days; or (b) You have suffered a Severe Cognitive Impairment requiring Substantial Supervision to protect You from threats to health and safety. (c) You must also: (i) Have been certified, within the past 12 months, as a Chronically Ill Individual by a Licensed Health Care Practitioner; and (ii) Have a written Plan of Care that prescribes the types of care, services and supplies for which You claim benefits. The Licensed Health Care Practitioner must be an employee of the a Care Coordination Provider Agency or an the Official Designee of a Care Coordination Provider Agency to prescribe the Plan of Care and certify You as a Chronically Ill Individual.