Aetna Home Care Plus

Every benefit below is transcribed from the Aetna Home Care Plus outline of coverage CLIHM03688NV (Nevada edition), for policy form CLIHCP16 NV, and from the Aetna Home Care Plus brochure CLIHM03744NV (Nevada edition), the Aetna Senior Supplemental Insurance company profile CGFMP08395, which states the A.M. Best rating and its date. Benefits, amounts and riders vary by state; the policy issued to you governs.

• Read this first: the home care benefit is weekly, and a week needs three visits Included

  It pays a weekly amount for each week the insured receives three or more medically necessary home care service visits, on separate days, of at least one hour per visit, in the insured’s home, from a home care practitioner. A week with two visits does not pay.

  Both other policies on our short-term home health care comparison page pay a DAILY benefit. This one does not, and the three-visit test is the difference between a claim and no claim in a light week. Settle what your care plan actually looks like before choosing between these designs.

• How much the home care benefit pays, and for how long Included

  Weekly units of $150, up to a maximum weekly benefit amount of $1,500, with a choice of 13, 26, 39 or 52 covered weeks and a waiting period of 0 or 20 days. The lifetime maximum is equal to twice the number of covered weeks. At least one unit must be bought.

  The benefit begins after the waiting period and is limited by the maximum benefit amount, the maximum number of weeks per period of care and the lifetime maximum number of weeks selected.

• It also pays a daily hospital confinement benefit Included

  A daily amount for each day the insured is confined in a hospital, including observation stays, available in $10 units up to a maximum daily benefit amount of $400, with 20 days per period of care and a lifetime maximum of 365 days. At least one unit must be bought alongside the home care benefit — this part is not sold on its own.

  This is a hospital indemnity benefit inside a home care policy. It is the reason the policy form is headed a limited benefit hospital indemnity AND home care indemnity policy, and it is why this one is worth comparing against the hospital indemnity page as well as this one.

• Optional rider: a lump sum if you are diagnosed with cancer Optional rider

  $2,500, $5,000 or $10,000, paid once per lifetime on a diagnosis of cancer made after the effective date and after a 30 day benefit waiting period. Only one cancer benefit amount is paid per insured person under the policy, and the rider ends when the policy ends or when that benefit is paid.

  Waiting period: 30 days. The diagnosis must be pathological — a microscopic examination of fixed tissue, blood samples or preparations from the hemic system. A clinical diagnosis, based on the study of symptoms, is accepted only where a pathological one cannot be made and the medical evidence substantially documents it.

• Optional rider: emergency room visits and ambulance Optional rider

  $200 when the insured has an emergency room visit and/or an ambulance service by air, ground or water, available twice per calendar year with no lifetime maximum. Both must be medically necessary and provided on an emergency basis.

  Only one benefit per day is payable even if the insured has an emergency room visit and an ambulance service on the same day.

• What the policy does not pay for Not covered

  Outpatient treatment, services or supplies of any type. Confinement in a hospice care facility. A stay in a community living center or a place that primarily provides domiciliary, retirement or educational care. Confinement or care received outside of the United States. Mental or nervous disorders or substance use disorders. Pregnancy and related services, except complications of pregnancy. Cosmetic surgery, routine foot care, dental services, acne or varicose veins. Diagnostic lab testing, x-rays, advanced studies and venipuncture. Allergy testing and allergy injections. Experimental or investigational procedures or participation in clinical trials. Infertility and impregnation procedures. Obesity or weight reduction, including bariatric surgery and complications resulting from it. Tobacco cessation. Routine newborn care. Sex transformation, and treatment of sexual function, dysfunction or inadequacy. Therapy or treatment of learning disorders or disabilities, developmental delays or sleep disorders. Voluntary abortion, except where the insured’s life would be endangered if the fetus were carried to term or where medical complications have arisen from an abortion. Voluntary sterilization or its reversal.

  “Outpatient treatment, services or supplies of any type” is the broadest line in that list and the easiest to read past. This policy pays for weeks of home care and days in a hospital bed, and essentially nothing else.

• And what no benefit under the policy will pay for Not covered

  War, an act of war, a riot or international armed conflict. The commission or attempted commission of a crime or felony, an illegal act, or time imprisoned. Suicide or attempted suicide or intentionally self-inflicted injury, whether while sane or insane. Skydiving, scuba diving, hang or ultra light gliding, ballooning, bungee jumping, para-kiting, riding an all-terrain vehicle such as a dirt bike, snowmobile or go-cart, racing with a motorcycle, motor vehicle, boat or any form of aircraft, any participation in sports for pay or profit, or participation in rodeo contests. Services provided by a home health care agency which has any financial relationship with any member of your family or with your physician, other than an arrangement to provide you home health care.

  That last one matters here more than it would on most policies: a family-connected agency is exactly the arrangement people reach for when care is needed at home.

• Medicare is not excluded, but most other government services are Included

  Service rendered by any agency of the federal or state government, other than Medicaid, is excluded unless you are legally obligated to pay for it. The outline states in terms that Medicare is not excluded.

Issue ages

50 to 89, age at last birthday, on the base benefits and on both riders.

Renewability

Guaranteed renewable for your life provided premiums are paid when due, subject to the policy termination provisions.

Pre-existing conditions

A pre-existing condition is one the insured has been medically diagnosed with, treated by, sought advice from, or consulted with a physician about during the six months before the coverage effective date. Pre-existing conditions are not covered unless the loss begins more than six months after the coverage effective date.

Financial strength

Rated “A” (Excellent) by A.M. Best as of 13 March 2024 — the third highest of sixteen ratings, which is the part the letter on its own does not tell you. It is a view of the insurer’s ability to pay claims, not a comment on this policy, and it can be changed at any time.

Policy form

CLIHCP16 NV. Form numbers and benefits vary by state.