Home Health Care Enhanced

Every benefit below is transcribed from ManhattanLife Home Health Care Enhanced brochure HHCE-BR 0326, and from the outline of coverage AS7008OCNV (Nevada edition), the application for home health care insurance AM7008APNV. Benefits, amounts and riders vary by state; the policy issued to you governs.

• Home health care, by the day Included

  A daily cash benefit for covered care in your home from an approved home health care practitioner, capped at a daily maximum aggregate of $150 on Classic, $300 on Premier and $450 on Deluxe, over a maximum benefit period of 365 days. Inside that aggregate the schedule pays per day, by plan: nursing care $75, $150 or $200; physical therapy, speech pathology and occupational therapy $75, $150 or $200 each; chemotherapy specialist services $60, $120 or $200; enterostomal therapy $50, $100 or $200; respiratory therapy $50, $100 or $200; medical social worker services $100, $200 or $300; and a home health care aide $50, $100 or $150.

  The maximum benefit period may vary by state. Each line is capped by the combined daily maximum rather than paid on top of it, and only one home health care aide benefit is payable in any 24-hour period however much care is given that day.

• Homemaker services — which your own family may provide Included

  $25 a day on Classic, $50 on Premier and $75 on Deluxe for help around the house, to a policy maximum of $4,000, $5,000 or $6,000. The outline of coverage says this may be provided by any individual, including immediate family members, and does not require professional certification.

  You must also be eligible for the home health care benefit, and before a day is paid a physician must certify that you have loss of functional capacity, have cognitive impairment, or are terminally ill. One benefit per 24-hour period.

• Prescription drugs Included

  $10 for each 30-day generic prescription and $25 for each 30-day brand-name one; $30 and $75 respectively for a 90-day supply. The policy year maximum is $300 on Classic, $600 on Premier and $900 on Deluxe.

  The pre-existing conditions limitation does not apply to this benefit. Drugs obtained from outside the United States are not covered, nor are vitamins, herbal or homeopathic products, minerals, appetite suppressants, dietary supplements, nutraceuticals or medical foods. The brochure says the prescription drug benefit is available in most states, so confirm it is available in yours.

• Restoration of benefits, with no limit on how often Included

  If you exhaust the maximum benefit period or the policy maximum and then recover, they restore in full. Two conditions: 180 consecutive days without receiving these services at home, and a physician certifying that you have recovered sufficiently, no longer require any services, and have not been advised to obtain them.

  The outline of coverage states there is no limit to the number of times this may happen. That is worth comparing against a policy with a lifetime cap before you choose between them.

• Routine annual physical examination rider Optional rider

  $150 for a routine annual physical examination, one per policy year.

  Waiting period: 12 months.

• Accidental death and dismemberment rider Optional rider

  $10,000 on accidental death. For dismemberment: sight in both eyes $5,000; sight in one eye $2,500; multiple hand, arm, foot or leg $5,000; a single one $2,500; multiple fingers or toes $500; a single one $250. Death or the loss must occur within 90 days of the covered accident and while the policy and rider are in force. Lifetime maximum $10,000.

  Only the highest single benefit is payable per accident, and where death and a dismemberment result from the same accident only the death benefit is paid.

• Home medical equipment rider Optional rider

  $100 for each piece of home medical equipment your physician prescribes while you are receiving home health care, to a lifetime maximum of $500. What counts is a closed list: mobility assistance (wheelchairs, walkers, rollators, canes, crutches), transfer aids (gait and transfer belts, benches, boards, mats), bathroom safety (shower chairs, elevated toilet seats, commode chairs), home accommodations (hospital beds, patient lifts, trapezes) and personal medical equipment (arm, leg, back and neck braces).

  The equipment must be the most appropriate model that meets your medical need, measured by Medicare guidelines. A replacement is covered only for a material change in clinical status or ordinary wear and tear, a duplicate never is, and unused benefit does not carry forward into another policy year.

• Ambulance rider Optional rider

  $200 for each one-way trip by professional ambulance for emergency care, or between medical facilities where health care is provided during the journey. Four trips a year, lifetime maximum $2,500.

  Not covered where the ambulance is used for your own, your family's or a provider's convenience.

• Accident expense rider Optional rider

  Two options, chosen at application. Option 1 pays a maximum of $1,250 per covered accident and Option 2 pays $2,500. Within that: hip or skull fracture $1,250 or $2,500; hip dislocation $1,000 or $2,000; knee ligament or meniscus tear $500 or $1,000; knee dislocation $500 or $1,000; all other fractures $250 or $500. Lifetime maximum $10,000.

  You must be diagnosed and treated by a licensed health care practitioner in a hospital emergency room, urgent care facility or physician's office within 48 hours of the accident — the outline of coverage shows that window written as 24, 48 or 72 hours depending on the policy schedule, so check the one you are issued. Nothing is payable for a fractured finger, toe, rib or coccyx, or a chipped, fractured or broken tooth.

Home Health Care Enhanced on its own page, with its own enrollment link.

Issue ages

18 to 89. One application can cover two people, and each of them picks their own plan and their own riders.

Underwriting

Simple underwriting. The application asks two health questions: whether you are currently living in a nursing home or assisted living facility or already receiving home health care or similar benefits, and whether you are physically unable to perform routine activities such as bathing, dressing, eating, toileting and transferring from bed to chair.

Renewability

Guaranteed renewable for life, with a 30 day free look to examine the policy and send it back. Premiums are based on your attained age, and the company may change the table of rates for everybody in the same class, with advance written notice.

Pre-existing conditions

Six months. A pre-existing condition is not covered for the first six (6) months you are insured, whether or not it was disclosed on the application — and the policy states that conditions named or described as excluded anywhere in it are never covered. The pre-existing limitation does not apply to the prescription drug benefit. Transcribed from the Nevada outline of coverage; the period may differ in another state.

Policy form

AS7008. Rider forms AM7008AB, AM7008AC, AM7008DD, AM7008DE, AM7008RE. Form numbers and benefits vary by state.