Once you’re eligible for benefits, our team of care coordinators will work with you to develop your plan of care based on your personal health information and care recommendations from your licensed health care practitioner.
Your plan of care identifies ways of meeting your needs for qualified long term care services. It will include details such as approved providers, dates of service, facility charges, hourly rates for caregivers, and quantified time for specific care services. It’s also used to validate invoices we receive for reimbursement.
Depending on your specific plan and coverage, we’ll work with you to find the appropriate care providers that best meet your personal needs. All providers must meet the qualifications established under your sharing program and additional standards that might be required to meet standard of care to be certified and included in an approved plan of care.
If you have comprehensive coverage, you may elect to receive care services in your home. You may use a formal caregiver, whose services are arranged and supervised by a home care agency, or an informal caregiver, whose services are arranged directly by you or a family member.
You may also elect to receive care in a facility. A facility may be an adult day care center, an assisted living facility, a nursing home, or a hospice facility.
Our care coordination team may approve alternative services to your plan of care that we deem to be both appropriate for you and cost-effective for the sharing program. The charges you incur for these alternative services must be approved before they are applied to a plan of care and submitted for reimbursement.
