The long term care plan will not pay benefits for a “loss of functional capacity”
if that loss begins before coverage goes into effect. Therefore, anyone
who has a loss of functional capacity before the effective date of the
coverage would not be eligible for benefits and should not apply for coverage.
Each
plan member receives an insurance certificate that includes full details
of plan exclusions. In addition, the plan does not pay benefits for certain
standard exclusions, such as losses due to:
- Certain hospital days covered under a medical plan;
- Certain confinements in government institutions;
- Self-inflicted injuries;
- Treatment received
outside the United States;
- Treatments covered
by workers’ compensation or similar laws; or
- War.
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