ACTIVITIES OF DAILY LIVING (ADL)
These include eating, dressing, bathing, continence, transferring, ambulating and toileting. ADLs are used to determine eligibility for benefits.
ADULT DAY CARE
A licensed adult day care program that provides both supervision and assistance with eating, dressing, toileting, moving, and taking medication.
ADULT DAY HEALTH CARE
Similar to Adult Day Care but includes medical services.
ASSISTED LIVING FACILITY
Assisted Living Facilities often provide supervision, meals, and assistance with ADLs. These facilities may combine independent living units with Residential Care Facilities. However, Assisted Living Facilities don’t have license requirements and shouldn’t be confused with Residential Care Facilities, which are licensed. Residential Care benefits require the use of a licensed facility.
Total amount available for a specific benefit each day.
This is the number of days you must pay for care before coverage begins. NPFBA offers 60 and 90-Day Elimination Periods. The Elimination Period need only be met once during a lifetime.
The necessary physical assistance of another person to help the Participant with ADLs.
HOME HEALTH CARE
Skilled Nursing or professional medical services provided in your home by a licensed caregiver.
Help with activities such as housekeeping or cooking that allow the Participant to remain in his/her home after the loss of ADLs.
INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL)
Activites such as using the phone, cooking, shopping for essentials, and managing medication.
The termination of coverage resulting from Participant’s failure to make payments.
If a Lapse occurs because of cognitive or functional impairment, the Participant may request reinstatement within 5 months of termination. Medical documentation and past due payments are required for reinstatement.
LOOK-BACK PERIOD FOR MEDI-CAL
The time period during which you may not transfer property or set up some types of trust to qualify for Medi-Cal. Medi-Cal could include any such transfers or trusts as part of your assets, which may result in ineligibility. The current Look-Back Period is 30 months.
A joint federal and state program to provide medical services to low-income people. Long-term care services are provided by Medi-Cal, however, the income and asset levels are very low. Please check with the California Department of Health and Human Services for exact income and asset levels.
A licensed facility that provides Skilled Nursing and Personal Care.
The physical or verbal assistance necessary for a person to perform ADLs and IADLs.
PLAN OF CARE
Written plan of services prescribed by a licensed health care provider. It should include the type and frequency of all services provided by both paid and unpaid caregivers.
You may within 1 year of coverage being terminated for non-payment apply for reinstatement. You must complete NPFBA medical documentation and pay all past due amounts for the period coverage was not in effect. Reinstatement is at the sole discretion of the Trustees.
RESIDENTIAL CARE FACILITY
These are licensed facilities that provide room and board as well as supervision and assistance with personal care.
Provides for the supervision and care of the Participant while the normal caregiver takes a short leave. Care must be provided by an eligible provider.
SEVERE COGNITIVE IMPAIRMENT
As the result of mental deterioration caused by Alzheimer’s disease or other mental disease, a person needs supervision or assistance to protect himself/herself and others.
Nursing and supportive care provided by a licensed nurse.
SKILLED NURSING FACILITY
A facility that provides room and board, 24-hour nursing care, a registered nurse on-duty or on call at all times, and a licensed physician available in emergencies.
WAIVER OF PAYMENT
Payments are waived while Participant is receiving benefits from NPFBA.
For Illustration only. See Plan Document for specific information.