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Benefits Provided by the Federal Long Term Care Insurance Program (FLTCIP)
Alternate Plan of Care
We may approve alternatives to your Written Plan of Care that we deem to be both appropriate for you and cost effective for the FLTCIP. An Alternate Plan of Care is one that:
- is designed specifically for you; and
- is primarily being made to improve your ability to perform one or more Activities of Daily Living; and
- is mutually agreed upon by you, a Licensed Health Care Practitioner and us; and
- contains recommendations for alternate services or supplies for you that are not otherwise covered under the Benefit Booklet; and may be modified as appropriate
- We will base our review of a request for an Alternate Plan of Care on the following: your medical status; current and future care plans; long-term cost projections for current and future care plans and the Alternate Plan of Care; and the suitability and effectiveness of the Alternate Plan of Care.
You may choose not to accept the final terms of the Alternate Plan of Care.
The Alternate Plan of Care may not be used:
- to pay for any charges for services or supplies described in the Exclusions section; or
- to supplement the maximum amount for any benefit under your Benefit Booklet; or
- to pay for expenses covered under the Stay-at-Home Benefit.
Benefits payable for charges incurred for services and supplies provided under the Alternate Plan of Care will not exceed the lesser of: the actual charges; or the appropriate charges for such services or supplies.
Your receipt of services for your care under an Alternate Plan of Care will be subject to the waiting period. The benefits we will pay for such services will be subject to the Maximum Benefit We Will Pay section.