How to Qualify for Benefits
You qualify for covered benefits when:

1. You need substantial assistance with at least two of six activities of daily living (bathing, eating, dressing, toileting, continence, transferring).  In addition, it is expected that you will need the substantial assistance for at least 90 days, OR;
2. You need substantial supervision because you have a severe cognitive impairment, which generally means that you have a significant deterioration in or loss of your intellectual capacity (e.g. Alzheimer's), AND;
3. Your doctor, a nurse, licensed social worker or Privileged Care Coordinator certifies from time to time that you need the assistance or supervision as described above.  In determining qualification for benefits, we can ask your doctor and your care providers for information that supports your need for care.   Benefits are paid to you for covered care and services you receive consistent with a Plan of Care that has been developed by a Privileged Care Coordinator, nurse, doctor or licensed social worker.