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Establishing Your Plan of Care

Establishing Your Plan of Care

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.

Deciding where your care will take place

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 the FLTCIP in order to be certified and included in an approved plan of care.

  • Home 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.
  • Facility care
    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.
  • Alternate plan of care and/or stay-at-home benefit
    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 FLTCIP. The charges you incur for these alternative services must be approved before they are applied to a plan of care and submitted for reimbursement. If you're enrolled in a FLTCIP 1.0 plan and have comprehensive coverage, supplemental items that enable you to remain at home, such as home modifications or durable medical equipment, may be authorized under an alternate plan of care. If you're enrolled in a FLTCIP 2.0 plan, your coverage includes a stay-at-home benefit that can pay benefits for certain equipment and services that support care in your home.

For detailed information about your specific plan and coverage, refer to the most recent FLTCIP Benefit Booklet we sent to you or review the downloadable PDF version within your online account.


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Using Your FLTCIP Benefits Brochure

If you've met the conditions for benefit eligibility, this brochure is intended to assist you at the time of claim by providing an overview of the process. It also contains important forms and instructions to assist you in the reimbursement of approved care expenses. There are two versions of this brochure: one for enrollees in a FLTCIP 1.0 plan and one for enrollees in a FLTCIP 2.0 plan.

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