Coverage Document Sample Clauses
A Coverage Document clause defines the official document that outlines the specific terms, conditions, and scope of insurance coverage provided under a policy. This clause typically identifies the document or set of documents that constitute the full agreement between the insurer and the insured, such as the policy schedule, endorsements, and any attached riders. By clearly specifying what constitutes the coverage document, this clause ensures that both parties understand which materials govern their rights and obligations, thereby reducing ambiguity and potential disputes over the extent of coverage.
Coverage Document. (Supports Facilitation) planning and delivery process. The facilitator counsels, facilitates, and assists in development of a self-directed care plan which includes both paid and unpaid services and supports designed to allow the individual to live in the home and participate in the community. A back-up plan is also developed to assure that the needed assistance will be provided if regular services identified in the self-directed care plan are temporarily unavailable. Self-Directed Goods and Services Self-directed goods and services are services, equipment or supplies not otherwise provided through LTSS or through the Medicaid State Plan that address an identified need and are in the approved self-directed care plan (including improving and maintaining the individual’s opportunities for full membership in the community) and meet the following requirements: the item or service would decrease the need for other Medicaid services and/or promote inclusion in the community; and/or the item or service would increase the individual’s ability to perform ADLs or IADLs and/or increase the person’s safety in the home environment; and, alternative funding sources are not available. Individual goods and services are purchased from the person’s self-directed budget through the fiscal intermediary when approved as part of the self-directed care plan. Examples include a laundry service for a person unable to launder and fold clothes or a microwave for a person unable to use a stove due to their disability. This will not include any good/service that would be restrictive to the individual or strictly experimental in nature. Financial Management Services (Fiscal Intermediary) Payroll services for the self-directed care program individuals: responsible for all taxes, fees, and insurances required for the self- directed care program. The individual is to act as an employer of record; manage all non-labor related payments for goods and services authorized in the participant’s approved spending plan; assure that all payments made comply with the person’s approved spending plan and conduct criminal background and abuse registry screens of all Enrollee’s employees. Senior Companion (Adult Companion Services) Non-medical care, supervision, and socialization, provided to a functionally impaired adult individual. Companions may assist or supervise the person with such tasks as meal preparation, laundry, and shopping. The provision of companion services does not entail hands-on nursi...
Coverage Document. A. The coverages and exclusions listed above are intended to broadly outline the program provided by the Pool.
B. A separate Coverage Document itemizing all coverage inclusions, exclusions and conditions is issued to each Pool Member.
C. Pool Members will be offered limits of liability of $1,000,000 or more, as confirmed by the Coverage Document.