Long Term Care Insurance Plan Coverage

Home Care Benefit

Your out-of-pocket home care expenses are reimbursed up to $100 per day, up to the lifetime benefit maximum, and are paid on a monthly basis. The ACE Life Long Term Care Insurance Plan allows you to choose between a $50,000 and a $100,000 lifetime benefit maximum amount to meet your personal needs and fit your budget.

Respite Care

To provide a break for the primary unpaid caregiver, you may hire another caregiver, or go into a facility for a maximum of two weeks per year. The maximum reimbursement for respite care is the daily benefit amount, for up to two weeks per year. This benefit is in addition to any benefit paid for home care services.

Care Coordinator

The Care Coordinator is a registered nurse, or licensed social worker, who will be assigned to help you at the time of claim. Specifically, the Care Coordinator will assist you in:

• completing the necessary forms
• developing a 'Plan of Care'
• coordinating your coverage
• locating home care providers
• monitoring your ongoing care needs

The Care Coordinator is based in your area and is familiar with the local services and resources. The Care Coordinator will help you find the type of care and providers you prefer so you get the most out of your coverage.

Who can apply?

The Long Term Care Insurance Plan is available to all union members, their spouses and eligible family members, between the ages of 20 and 75 inclusive. Eligible family members include children and their spouses, siblings and their spouses, and parents.

Eligibility for Benefits

To qualify for benefits under the plan, you must receive a Plan of Care Assessment that indicates you:

• need help with at least two out of the six Activities of Daily Living (ADLs), including bathing, dressing, toileting, eating, transferring and continence
• or that you have a cognitive impairment, such as Alzheimer's Disease, that requires you to have supervision to maintain your health and safety.

You will also need to satisfy the 90-day waiting period and submit your receipts for formal care provided. Once your claim is approved, you will be reimbursed for your home care related expenses, up to the maximum daily benefit of $100 and the lifetime benefit amount you have chosen.

Waiting Period

There is a 90-day waiting, or 'elimination' period, associated with each period of care during which benefits are not payable. This waiting period begins on the first documented day that you require assistance and continues for 90 consecutive calendar days. Once you have satisfied the waiting period, your benefits become payable. Having a waiting period helps to keep premiums affordable.

Exclusions and Limitations

Benefits are not payable for care, treatment or services:

• provided by a family member
• not provided by a home health agency, home care agency or adult day care centre
• for which no charge is normally made in the absence of insurance
• provided outside Canada and the United States
• provided in a long term care facility
• due to an illness, treatment or medical condition arising out of attempted suicide or intentionally self-inflicted injury, while sane or insane
• due to an illness, treatment or medical condition arising out of participation in a felony, riot, insurrection, war and act of war (whether declared or undeclared)
• due to alcoholism, drug addiction or other chemical dependence; however, this exclusion does not apply to a drug dependency sustained or acquired at the hands of, or while under treatment by, a physician in the course of treatment for an injury or sickness
• due to mental or nervous disorders without demonstrable organic cause. Brain disorders with demonstrable organic cause (such as Alzheimer's Disease and related dementia) are covered if symptoms are exhibited or a diagnosis is made

There are a number of special benefits such as waiver of premium while on claim and a guarantee that once your in the Plan it can be renewed yearly.