Essential Care II Limitations• Benefits will not be paid for changes during the Elimination Period.
• Benefits will not be paid in excess of the policy limit, except for Care Advisory Services and the Stay at Home Benefit.
• If you received services covered under the Nursing Home Benefit, Assisted Living Facility Benefit, and the Home Health Care benefit on the same day, the only benefit payable for that day will be the greatest of the three benefits.
• This policy contains a coordination of benefits provision: we may reduce benefits payable under this policy for long-term care services if we also pay benefits for such services under any other individual long-term care policy issued by us. This includes policies providing nursing home, assisted living facility and or home heath care coverage, whether payable on an expense reimbursement, indemnity or any other basis.
Exceptions
• This policy does not cover care, treatment or charges:
– for intentionally self-inflicted injury
– required as a result of alcoholism or drug addition (unless the drug addition was a result of the administration of drugs as part of treatment by physician)
– due to war (declared or undeclared) or any act of war, or service in any of the armed forces or auxiliary units
– due to participation in a felony, riot, or insurrection
– normally not made in the absence of insurance
• This policy does not cover care, treatment or charges:
– provided by a member of your immediate family, unless:
• the family member is one of the following professionals: a duly licensed registered nurse, licensed vocational nurse, licensed practical nurse, physical therapist, occupational therapist, speech therapist, respiratory therapist, licensed social worker, or register dietitian;
• the family member is a regular employee of an organization (e.g. nursing home, assisted living facility, adult day care center, or home health care agency) which is providing the services;
• This policy does not cover care, treatment or charges:
– provided by a member of your immediate family, unless:
• the organization receives the payment for the services; and
• their family member receives not compensation other than the normal compensation for employees in his or her job category
– provided outside the 50 United States and the District of Columbia, except as described in the International Coverage
section of the policy
• This policy does not cover items or services furnished at your request for beautification convenience, or entertainment.
• In Massachusetts, the policy does not cover alcoholism or drug detoxification.
• In Connecticut there is no exclusion of service in the armed forces
• In North Carolina, the coordination of benefits provision is not applicable.
Thank you!
This is a general description of coverage and is not an insurance contract. Refer to the Outline of Coverage provided by our agent for an explanation of features and options. Only the individual long-term care insurance policy contains governing contractual provisions. You may request a sample policy to review such provisions.
The Long-Term Care insurance policy describes coverage’s provided under the policy, exclusions, limitations, any reductions in benefits, what you must do to keep your policy in force,and what would cause your policy to be discontinued. Please contact John Hancock or your Insurance Representative for information, costs, and complete details on coverage.
Long-Term Care Insurance is underwritten by John Hancock Life Insurance Company,
Boston, Massachusetts, 02117
