MMC Benefits Handbook
How the Plan Works
This Plan helps pay for the care you or a covered eligible family member may require as a result of an illness, an accident, or age. This care may be needed for a lengthy period of time, either in your home or in a facility that provides long-term care.
In the event of a conflict among the terms in this Summary Plan Description and the Certificate of Coverage, the Certificate of Coverage will govern. You will receive a Certificate of Coverage from Genworth once your application is processed and approved.
What is long-term care?
Long-term care refers to the services and assistance you or a family member could need as a result of an illness, an accident, or age.
This care may be needed when someone becomes unable to care for himself or herself and requires help doing everyday activities like dressing, eating, bathing, continence, toileting and transferring. Just as it sounds, long-term care is about needing care for a lengthy period of time, either in your home or in a facility that provides long-term care services.
If I am on an authorized unpaid leave of absence or am disabled, does the Plan still provide a benefit?
You will be able to continue paying for your coverage, at your current premium, on a direct bill basis with Genworth. You should contact Genworth to see if you qualify to collect Long Term Care Benefits.
How do I or my covered family member qualify for benefits; is there a "waiting period"?
To be eligible for benefits, Genworth must receive:
- An eligibility certification, signed by a Licensed Health Care Practitioner during the preceding 12 month period, that the insured is a chronically ill individual; and
- Ongoing proof that demonstrates the Covered Care received is needed due to the insured continually being a Chronically Ill individual.
Before benefits are payable, the Elimination Period must be satisfied. The Elimination Period is a period of 90 calendar days during which the insured remains a Chronically Ill individual before benefits are payable. The Elimination Period begins on the first day that the insured is both a Chronically Ill individual and incurs a Covered Expense. However, the insured is not required to continue to incur covered expenses to satisfy the Elimination Period. The insured must remain a Chronically Ill individual for each consecutive day after the first day of the Elimination Period in order to satisfy the Elimination Period. The Elimination Period needs to be met only once during the insured's lifetime.
When will I or my covered eligible family members be qualified to receive long-term care?
You or your covered eligible family member must be certified as chronically ill.
Can I choose where to receive my care?
Yes, you can choose where to receive care.
Care Coordination Services
Can I receive help in making my decisions on what kind of care to receive?
Yes. Care Coordination Services will provide you with a team of Covered Care Coordinators who will review your specific situation and develop Plans of Care to meet your needs. You or your family should contact Genworth when you choose to use the services of a Covered Care Coordinator. Covered Care Coordinators will work with you to identify the specific services and care providers you require.
Care Coordination Services are furnished by a team of Covered Care Coordinators provided by Genworth at no cost to the insured. Genworth will pay for these services when the insured receives them while the insured's coverage is in effect. The payments will be at Genworth's expense; and will not count against any payment maximum.
What is the role of Covered Care Coordinators?
Professional care coordinators review the insured's specific situation and develop an appropriate Plan of Care to meet those needs. The cost of this service is not deducted from the Policy Lifetime Maximum.
Do I have to use Care Coordination Services?
No. Care Coordination Services are voluntary.
When do I need to contact Genworth regarding Care Coordination Services?
You or your family should contact Genworth when you choose to use the services of a Covered Care Coordinator. Genworth will then make arrangements for a Covered Care Coordinator to contact you and begin providing you with this assistance.