Citi Benefits Handbook
Coordination of Benefits and Exclusions
To prevent duplication of benefits, the LTC Plan contains a coordination of benefits provision that may reduce or eliminate the benefits otherwise payable under the LTC Plan when benefits are payable under another plan. (This provision does not apply to residents of Connecticut.)
John Hancock will not pay benefits for charges incurred in certain circumstances, such as intentional self-inflicted injury; charges that are reimbursable or would be reimbursable under Medicare except for coinsurance, copayment or deductible provisions under Medicare; or for treatment specifically provided for detoxification or rehabilitation for alcohol or drug addiction.
These exclusions may not apply in all states and may vary depending on the state in which you live. The Certificate of Insurance you will receive once you are approved for coverage will outline the exclusions for your state. If you move to another state, the state guidelines where the Certificate of Insurance was originally delivered to you will apply.
LTC providers must meet the qualifications specified in the Certificate of Insurance, and services and supplies must be provided in accordance with a plan of care prescribed by a licensed health care practitioner.