This is a solicitation of insurance. Long-term care insurance is underwritten by Mutual of Omaha Insurance Company, Mutual of Omaha Plaza, Omaha, NE 68175-0001. Policy forms LTC09M, LTC09M-AG (or state equivalent). In ID: LTC09M-ID, LTC09M-AG-ID, In NY: LTC09M-NY, LTC09M-AG-NY, In OK: LTC09M-OK, LTC09M-AG-OK, In OR: LTC09[-AG, -5ML, -10ML]-OR, In PA: LTC09M-PA, LTC09M-AG-PA, In TX: LTC09M-TX, LTC09M-AG-TX, In WA: LTC09M-WA, LTC09M-AG-WA. Coverage may vary by state. These policies have exceptions and limitations. You may be contacted by telephone by an insurance agent.
We will not pay benefits for: services provided from a Family Member; services for which no charge
would be made in the absence of insurance; for services provided outside of the United States, its
possessions or territories, Canada or the United Kingdom (except as provided in the
INTERNATIONAL BENEFIT section of this policy); services provided due to suicide (while sane
or insane), attempted suicide or an intentionally self-inflicted injury; for treatment of alcoholism or
drug addiction (except for an addiction to a prescription medication when administered in accordance
with the advice of your Physician); for treatment of mental or nervous disorders (except for
Alzheimer's disease); for treatment provided in a government facility unless we are required by law to
cover the charges; for treatment of an injury or sickness which would entitle you to benefits under any
any state or federal workers’ compensation, employer’s liability or occupational disease law, or any
motor vehicle no-fault law; services provided due to an act of declared or undeclared war.
LIMITATIONS OR CONDITIONS ON ELIGIBILITY OF BENEFITS
Except as otherwise provided in the policy, you must incur eligible expenses for Qualified Long-Term
Care Services in order to receive benefits under the policy. Such Qualified Long-Term Care Services
must be specified in a Plan of Care prepared for you by a Licensed Health Care Practitioner. Except
for Stay-At-Home Benefits, if you are eligible for more than one type of benefit under the policy on a
single day, we will pay the benefit which pays the greater amount.
Satisfying the Elimination Period
Except as otherwise provided in the policy, we will not pay benefits for eligible expenses incurred
during the Elimination Period. The Elimination Period commences on the first day you are eligible for
benefits under the policy and on which you: (a) are confined to a Nursing Home (b) receive Home
Health Care or Adult Day Care; or (c) receive long-term care services covered under the policy that are
Medicare eligible (for which benefits are not payable under the policy). The Elimination Period must
be satisfied only once during the term of the policy.
Maximum Lifetime Benefit
Except as otherwise provided in the policy, any benefits paid under the policy will reduce the amount
of your maximum lifetime benefit. No additional benefits are payable under the policy once the
maximum lifetime benefit has been reduced to zero.
Non-Duplication of Benefits
We will not pay benefits under the policy to the extent that eligible expenses are reimbursable under
Medicare or other government program (except Medicaid) or would be so reimbursable except for the
application of a deductible or coinsurance amount.
Coordination of Benefits
Benefits under the policy may be reduced if benefits for eligible expenses are paid by us or one of our
affiliates under another individual long-term care insurance policy. Benefits will be reduced under the
policy only when payment under the policy and such other long-term care insurance policy(ies)
combined would exceed the actual amount you incur for eligible expenses. In no event will we pay
more under this policy than the difference between your actual eligible expenses and the amount
payable by such other long-term care insurance policy(ies).
If you are insured under one or more policies without a similar Coordination of Benefits provision,
such policy(ies) will be deemed primary and pay benefits first. Then, payment will be made under any
policy without a similar Coordination of Benefits provision in order of effective date, from the earliest
to the latest.
THE POLICY MAY NOT COVER ALL THE EXPENSES ASSOCIATED WITH YOUR LONGTERM CARE NEEDS.
¹Oregon and Washington Residents: the term “agent” is considered “producer” in your state.