Common use of Third Party Private Insurance and Managed Care Clause in Contracts

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan and the Facility. Residents who are members of a managed care benefit plan that has a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services not covered under his or her plan and for applicable copayments, coinsurance and/or deductibles. If the Resident is covered by a private insurance plan or managed care benefit plan that does not have a contract with the Facility, and where the private insurance or managed care plan reimbursement is insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. The Facility will bill the Resident for any such difference on a monthly basis as described in the “Private Payment” section above The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating provider with the understanding that there may be additional charges to the Resident for using such nonparticipating providers.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan and the Facility. Residents who are members of a managed care benefit plan that has a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services not covered under his or her plan and for applicable copayments, coinsurance and/or deductibles. If the Resident is covered by a private insurance plan or managed care benefit plan that does not have a contract with the Facility, and where the private insurance or managed care plan reimbursement is insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. . The Facility will bill the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating provider with the understanding that there may be additional charges to the Resident for using such nonparticipating providers.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment of his or her care will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan set forth in the written financial agreement with the Facility and the Facilitythird party insurer or managed care payor. Residents who are members of a managed care benefit plan that has is under a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services that are not included in the list of covered services under his or her plan and for applicable copayments, coinsurance and/or co-pays and deductibles. If the Resident is covered by a private insurance plan or under a managed care benefit plan that does not have a contract with the Facility, and where the insurance proceeds under the private insurance or managed care plan reimbursement is are insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. difference. The Facility will bill xxxx the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff staff, the business office and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating non-participating provider with the understanding and agreement that there the Resident will be responsible for the additional charges, if any, as a result of using such non-participating providers. Alternate Physician or Professional Provider of Service: The Resident and Responsible Party agree that if the physician or any other professional provider of service designated by the Resident or Responsible party is not available to serve the Resident, fails to serve the Resident, or fails to comply with any applicable provision of federal or state law, the Facility is authorized to obtain the services of a substitute physician or professional provider of service. Payment for such services will be made in accordance with this Agreement. The Resident is responsible for timely advising the Facility of what benefits, if any, may be additional charges available from his or her private insurance and/or managed care plan. Charges may be assessed above the covered benefit for skilled nursing facility care depending on the insurance coverage, managed care plan and/or written agreement with the Facility. Furthermore, the Resident’s coverage may be subject to co-insurance, deductibles and/or co- payments which will be the Resident’s responsibility and billed according to the Resident terms for using such nonparticipating providersprivate payment stated above. In the event of denial of payment by a third-party payor, exhaustion of benefits and/or termination of coverage, the Resident, Designated Representative and/or Sponsor shall be responsible (in accordance with the terms and provisions of this Agreement) for payment to the Facility as described in the “Private Pay” section above and in accordance with applicable law.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment of his or her care will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan set forth in the written financial agreement with the Facility and the Facilitythird party insurer or managed care payor. Residents who are members of a managed care benefit plan that has is under a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services that are not included in the list of covered services under his or her plan and for applicable copayments, coinsurance and/or co-pays and deductibles. If the Resident is covered by a private insurance plan or under a managed care benefit plan that does not have a contract with the Facility, and where the insurance proceeds under the private insurance or managed care plan reimbursement is are insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. difference. The Facility will bill the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff staff, the business office and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating non-participating provider with the understanding and agreement that there the Resident will be responsible for the additional charges, if any, as a result of using such non-participating providers. Alternate Physician or Professional Provider of Service: The Resident and Responsible Party agree that if the physician or any other professional provider of service designated by the Resident or Responsible party is not available to serve the Resident, fails to serve the Resident, or fails to comply with any applicable provision of federal or state law, the Facility is authorized to obtain the services of a substitute physician or professional provider of service. Payment for such services will be made in accordance with this Agreement. The Resident is responsible for timely advising the Facility of what benefits, if any, may be additional charges available from his or her private insurance and/or managed care plan. Charges may be assessed above the covered benefit for skilled nursing facility care depending on the insurance coverage, managed care plan and/or written agreement with the Facility. Furthermore, the Resident’s coverage may be subject to co-insurance, deductibles and/or co- payments which will be the Resident’s responsibility and billed according to the Resident terms for using such nonparticipating providersprivate payment stated above. In the event of denial of payment by a third-party payor, exhaustion of benefits and/or termination of coverage, the Resident, Designated Representative and/or Sponsor shall be responsible (in accordance with the terms and provisions of this Agreement) for payment to the Facility as described in the “Private Pay” section above and in accordance with applicable law.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment of his or her care will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan set forth in the written financial agreement with the Facility and the Facilitythird party insurer or managed care payor. Residents who are members of a managed care benefit plan that has is under a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services that are not included in the list of covered services under his or her plan and for applicable copayments, coinsurance and/or co-pays and deductibles. If the Resident is covered by a private insurance plan or under a managed care benefit plan that does not have a contract with the Facility, and where the insurance proceeds under the private insurance or managed care plan reimbursement is are insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. difference. The Facility will bill xxxx the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff staff, the business office and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating non-participating provider with the understanding and agreement that there the Resident will be responsible for the additional charges, if any, as a result of using such non-participating providers. Alternate Physician or Professional Provider of Service: The Resident and/or Designated Representative and/or Sponsor agree that if the physician or any other professional provider of service designated by the Resident and/or Designated Representative and/or Sponsor is not available to serve the Resident, fails to serve the Resident, or fails to comply with any applicable provision of federal or state law, the Facility is authorized to obtain the services of a substitute physician or professional provider of service. Payment for such services will be made in accordance with this Agreement. The Resident is responsible for timely advising the Facility of what benefits, if any, may be additional charges available from his or her private insurance and/or managed care plan. Charges may be assessed above the covered benefit for skilled nursing facility care depending on the insurance coverage, managed care plan and/or written agreement with the Facility. Furthermore, the Resident’s coverage may be subject to co-insurance, deductibles and/or copayments which will be the Resident’s responsibility and billed according to the Resident terms for using such nonparticipating providersprivate payment stated above. In the event of denial of payment by a third-party payor, exhaustion of benefits and/or termination of coverage, the Resident, Designated Representative and/or Sponsor shall be responsible (in accordance with the terms and provisions of this Agreement) for payment to the Facility as described in the “Private Pay” section above and in accordance with applicable law.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment of his or her care will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan set forth in the written financial agreement with the Facility and the Facilitythird party insurer or managed care payor. Residents who are members of a managed care benefit plan that has is under a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services that are not included in the list of covered services under his or her plan and for applicable copayments, coinsurance and/or co-pays and deductibles. If the Resident is covered by a private insurance plan or under a managed care benefit plan that does not have a contract with the Facility, and where the insurance proceeds under the private insurance or managed care plan reimbursement is are insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. difference. The Facility will bill the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff staff, the business office and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating non-participating provider with the understanding and agreement that there the Resident will be responsible for the additional charges, if any, as a result of using such non-participating providers. Alternate Physician or Professional Provider of Service: The Resident and Designated Representative agree that if the physician or any other professional provider of service designated by the Resident or Designated Representative is not available to serve the Resident, fails to serve the Resident, or fails to comply with any applicable provision of federal or state law, the Facility is authorized to obtain the services of a substitute physician or professional provider of service. Payment for such services will be made in accordance with this Agreement. The Resident is responsible for timely advising the Facility of what benefits, if any, may be additional charges available from his or her private insurance and/or managed care plan. Charges may be assessed above the covered benefit for skilled nursing facility care depending on the insurance coverage, managed care plan and/or written agreement with the Facility. Furthermore, the Resident’s coverage may be subject to co-insurance, deductibles and/or co- payments which will be the Resident’s responsibility and billed according to the Resident terms for using such nonparticipating providersprivate payment stated above. In the event of denial of payment by a third-party payor, exhaustion of benefits and/or termination of coverage, the Resident, Designated Representative and/or Sponsor shall be responsible (in accordance with the terms and provisions of this Agreement) for payment to the Facility as described in the “Private Pay” section above and in accordance with applicable law.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment of his or her care will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan set forth in the written financial agreement with the Facility and the Facilitythird party insurer or managed care payor. Residents who are members of a managed care benefit plan that has is under a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services that are not included in the list of covered services under his or her plan and for applicable copayments, coinsurance and/or co-pays and deductibles. If the Resident is covered by a private insurance plan or under a managed care benefit plan that does not have a contract with the Facility, and where the insurance proceeds under the private insurance or managed care plan reimbursement is are insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. difference. The Facility will bill the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff staff, the business office and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating non-participating provider with the understanding and agreement that there the Resident will be responsible for the additional charges, if any, as a result of using such non-participating providers. Alternate Physician or Professional Provider of Service: The Resident and/or Designated Representative and/or Sponsor agree that if the physician or any other professional provider of service designated by the Resident and/or Designated Representative and/or Sponsor is not available to serve the Resident, fails to serve the Resident, or fails to comply with any applicable provision of federal or state law, the Facility is authorized to obtain the services of a substitute physician or professional provider of service. Payment for such services will be made in accordance with this Agreement. The Resident is responsible for timely advising the Facility of what benefits, if any, may be additional charges available from his or her private insurance and/or managed care plan. Charges may be assessed above the covered benefit for skilled nursing facility care depending on the insurance coverage, managed care plan and/or written agreement with the Facility. Furthermore, the Resident’s coverage may be subject to co-insurance, deductibles and/or co- payments which will be the Resident’s responsibility and billed according to the Resident terms for using such nonparticipating providersprivate payment stated above. In the event of denial of payment by a third-party payor, exhaustion of benefits and/or termination of coverage, the Resident, Designated Representative and/or Sponsor shall be responsible (in accordance with the terms and provisions of this Agreement) for payment to the Facility as described in the “Private Pay” section above and in accordance with applicable law.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment of his or her care will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan set forth in the written financial agreement with the Facility and the Facilitythird party insurer or managed care payor. Residents who are members of a managed care benefit plan that has is under a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services that are not included in the list of covered services under his or her plan and for applicable copayments, coinsurance and/or co-pays and deductibles. If the Resident is covered by a private insurance plan or under a managed care benefit plan that does not have a contract with the Facility, and where the insurance proceeds under the private insurance or managed care plan reimbursement is are insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. difference. The Facility will bill xxxx the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff staff, the business office and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating non-participating provider with the understanding and agreement that there the Resident will be responsible for the additional charges, if any, as a result of using such non-participating providers. Alternate Physician or Professional Provider of Service: The Resident and Responsible Party agree that if the physician or any other professional provider of service designated by the Resident or Responsible party is not available to serve the Resident, fails to serve the Resident, or fails to comply with any applicable provision of federal or state law, the Facility is authorized to obtain the services of a substitute physician or professional provider of service. Payment for such services will be made in accordance with this Agreement. The Resident is responsible for timely advising the Facility of what benefits, if any, may be additional charges available from his or her private insurance and/or managed care plan. Charges may be assessed above the covered benefit for skilled nursing facility care depending on the insurance coverage, managed care plan and/or written agreement with the Facility. Furthermore, the Resident’s coverage may be subject to co-insurance, deductibles and/or copayments which will be the Resident’s responsibility and billed according to the Resident terms for using such nonparticipating providersprivate payment stated above. In the event of denial of payment by a third-party payor, exhaustion of benefits and/or termination of coverage, the Resident, Designated Representative and/or Sponsor shall be responsible (in accordance with the terms and provisions of this Agreement) for payment to the Facility as described in the “Private Pay” section above and in accordance with applicable law.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment of his or her care will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan set forth in the written financial agreement with the Facility and the Facilitythird party insurer or managed care payor. Residents who are members of a managed care benefit plan that has is under a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services that are not included in the list of covered services under his or her plan and for applicable copayments, coinsurance and/or co-pays and deductibles. If the Resident is covered by a private insurance plan or under a managed care benefit plan that does not have a contract with the Facility, and where the insurance proceeds under the private insurance or managed care plan reimbursement is are insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. difference. The Facility will bill xxxx the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff staff, the business office and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating non-participating provider with the understanding and agreement that there the Resident will be responsible for the additional charges, if any, as a result of using such non-participating providers. Alternate Physician or Professional Provider of Service: The Resident and/or Designated Representative and/or Sponsor agree that if the physician or any other professional provider of service designated by the Resident and/or Designated Representative and/or Sponsor is not available to serve the Resident, fails to serve the Resident, or fails to comply with any applicable provision of federal or state law, the Facility is authorized to obtain the services of a substitute physician or professional provider of service. Payment for such services will be made in accordance with this Agreement. The Resident is responsible for timely advising the Facility of what benefits, if any, may be additional charges available from his or her private insurance and/or managed care plan. Charges may be assessed above the covered benefit for skilled nursing facility care depending on the insurance coverage, managed care plan and/or written agreement with the Facility. Furthermore, the Resident’s coverage may be subject to co-insurance, deductibles and/or co- payments which will be the Resident’s responsibility and billed according to the Resident terms for using such nonparticipating providersprivate payment stated above. In the event of denial of payment by a third-party payor, exhaustion of benefits and/or termination of coverage, the Resident, Designated Representative and/or Sponsor shall be responsible (in accordance with the terms and provisions of this Agreement) for payment to the Facility as described in the “Private Pay” section above and in accordance with applicable law.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan and the Facility. Residents who are members of a managed care benefit plan that has a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services not covered under his or her plan and for applicable copayments, coinsurance and/or deductibles. If the Resident is covered by a private insurance plan or managed care benefit plan that does not have a contract with the Facility, and where the private insurance or managed care plan reimbursement is insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. . The Facility will bill the Resident for any such difference on a monthly basis as described in the “Private Payment” section above sectionabove. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff and/or staffand/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, ,but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating provider with the understanding that there may be additional charges to the Resident for using such nonparticipating providers.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment of his or her care will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan set forth in the written financial agreement with the Facility and the Facilitythird party insurer or managed care payor. Residents who are members of a managed care benefit plan that has is under a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services that are not included in the list of covered services under his or her plan and for applicable copayments, coinsurance and/or co-pays and deductibles. If the Resident is covered by a private insurance plan or under a managed care benefit plan that does not have a contract with the Facility, and where the insurance proceeds under the private insurance or managed care plan reimbursement is are insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. difference. The Facility will bill xxxx the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff staff, the business office and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating non-participating provider with the understanding and agreement that there the Resident will be responsible for the additional charges, if any, as a result of using such non-participating providers. Alternate Physician or Professional Provider of Service: The Resident and Designated Representative agree that if the physician or any other professional provider of service designated by the Resident or Designated Representative is not available to serve the Resident, fails to serve the Resident, or fails to comply with any applicable provision of federal or state law, the Facility is authorized to obtain the services of a substitute physician or professional provider of service. Payment for such services will be made in accordance with this Agreement. The Resident is responsible for timely advising the Facility of what benefits, if any, may be additional charges available from his or her private insurance and/or managed care plan. Charges may be assessed above the covered benefit for skilled nursing facility care depending on the insurance coverage, managed care plan and/or written agreement with the Facility. Furthermore, the Resident’s coverage may be subject to co-insurance, deductibles and/or co- payments which will be the Resident’s responsibility and billed according to the Resident terms for using such nonparticipating providersprivate payment stated above. In the event of denial of payment by a third-party payor, exhaustion of benefits and/or termination of coverage, the Resident, Designated Representative and/or Sponsor shall be responsible (in accordance with the terms and provisions of this Agreement) for payment to the Facility as described in the “Private Pay” section above and in accordance with applicable law.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment of his or her care will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan set forth in the written financial agreement with the Facility and the Facilitythird party insurer or managed care payor. Residents who are members of a managed care benefit plan that has is under a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services that are not included in the list of covered services under his or her plan and for applicable copayments, coinsurance and/or co-pays and deductibles. If the Resident is covered by a private insurance plan or under a managed care benefit plan that does not have a contract with the Facility, and where the insurance proceeds under the private insurance or managed care plan reimbursement is are insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. difference. The Facility will bill the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff staff, the business office and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating non-participating provider with the understanding and agreement that there the Resident will be responsible for the additional charges, if any, as a result of using such non-participating providers. Alternate Physician or Professional Provider of Service: The Resident and Designated Representative agree that if the physician or any other professional provider of service designated by the Resident or Designated Representative is not available to serve the Resident, fails to serve the Resident, or fails to comply with any applicable provision of federal or state law, the Facility is authorized to obtain the services of a substitute physician or professional provider of service. Payment for such services will be made in accordance with this Agreement. The Resident is responsible for timely advising the Facility of what benefits, if any, may be additional charges available from his or her private insurance and/or managed care plan. Charges may be assessed above the covered benefit for skilled nursing facility care depending on the insurance coverage, managed care plan and/or written agreement with the Facility. Furthermore, the Resident’s coverage may be subject to co-insurance, deductibles and/or co-payments which will be the Resident’s responsibility and billed according to the Resident terms for using such nonparticipating providersprivate payment stated above. In the event of denial of payment by a third-party payor, exhaustion of benefits and/or termination of coverage, the Resident, Designated Representative and/or Sponsor shall be responsible (in accordance with the terms and provisions of this Agreement) for payment to the Facility as described in the “Private Pay” section above and in accordance with applicable law.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan and the Facility. Residents who are members of a managed care benefit plan that has a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services not covered under his or her plan and for applicable copayments, coinsurance and/or deductibles. If the Resident is covered by a private insurance plan or managed care benefit plan that does not have a contract with the Facility, and where the private insurance or managed care plan reimbursement is insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. The Facility will bill xxxx the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating provider with the understanding that there may be additional charges to the Resident for using such nonparticipating providers.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan and the Facility. Residents who are members of a managed care benefit plan that has a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services not covered under his or her plan and for applicable copayments, coinsurance and/or deductibles. If the Resident is covered by a private insurance plan or managed care benefit plan that does not have a contract with the Facility, and where the private insurance or managed care plan reimbursement is insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. The Facility will bill the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating provider with the understanding that there may be additional charges to the Resident for using such nonparticipating providers.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan and the Facility. Residents who are members of a managed care benefit plan that has a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services not covered under his or her plan and for applicable copayments, coinsurance and/or deductibles. If the Resident is covered by a private insurance plan or managed care benefit plan that does not have a contract with the Facility, and where the private insurance or managed care plan reimbursement is insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. . The Facility will bill xxxx the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating provider with the understanding that there may be additional charges to the Resident for using such nonparticipating providers.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment of his or her care will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan set forth in the written financial agreement with the Facility and the Facilitythird party insurer or managed care payor. Residents who are members of a managed care benefit plan that has is under a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services that are not included in the list of covered services under his or her plan and for applicable copayments, coinsurance and/or co-pays and deductibles. If the Resident is covered by a private insurance plan or under a managed care benefit plan that does not have a contract with the Facility, and where the insurance proceeds under the private insurance or managed care plan reimbursement is are insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. difference. The Facility will bill xxxx the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff staff, the business office and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating non-participating provider with the understanding and agreement that there the Resident will be responsible for the additional charges, if any, as a result of using such non-participating providers. Alternate Physician or Professional Provider of Service: The Resident and/or Designated Representative and/or Sponsor agree that if the physician or any other professional provider of service designated by the Resident and/or Designated Representative and/or Sponsor is not available to serve the Resident, fails to serve the Resident, or fails to comply with any applicable provision of federal or state law, the Facility is authorized to obtain the services of a substitute physician or professional provider of service. Payment for such services will be made in accordance with this Agreement. The Resident is responsible for timely advising the Facility of what benefits, if any, may be additional charges available from his or her private insurance and/or managed care plan. Charges may be assessed above the covered benefit for Admission Agreement (7/2015) skilled nursing facility care depending on the insurance coverage, managed care plan and/or written agreement with the Facility. Furthermore, the Resident’s coverage may be subject to co-insurance, deductibles and/or co-payments which will be the Resident’s responsibility and billed according to the Resident terms for using such nonparticipating providersprivate payment stated above. In the event of denial of payment by a third-party payor, exhaustion of benefits and/or termination of coverage, the Resident, Designated Representative and/or Sponsor shall be responsible (in accordance with the terms and provisions of this Agreement) for payment to the Facility as described in the “Private Pay” section above and in accordance with applicable law.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment of his or her care will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan set forth in the written financial agreement with the Facility and the Facilitythird party insurer or managed care payor. Residents who are members of a managed care benefit plan that has is under a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services that are not included in the list of covered services under his or her plan and for applicable copayments, coinsurance and/or co-pays and deductibles. If the Resident is covered by a private insurance plan or under a managed care benefit plan that does not have a contract with the Facility, and where the insurance proceeds under the private insurance or managed care plan reimbursement is are insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. difference. The Facility will bill xxxx the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff staff, the business office and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating non-participating provider with the understanding and agreement that there the Resident will be responsible for the additional charges, if any, as a result of using such non-participating providers. Alternate Physician or Professional Provider of Service: The Resident and/or Designated Representative and/or Sponsor agree that if the physician or any other professional provider of service designated by the Resident and/or Designated Representative and/or Sponsor is not available to serve the Resident, fails to serve the Resident, or fails to comply with any applicable provision of federal or state law, the Facility is authorized to obtain the services of a substitute physician or professional provider of service. Payment for such services will be made in accordance with this Agreement. Admission Agreement (7/2015) The Resident is responsible for timely advising the Facility of what benefits, if any, may be additional charges available from his or her private insurance and/or managed care plan. Charges may be assessed above the covered benefit for skilled nursing facility care depending on the insurance coverage, managed care plan and/or written agreement with the Facility. Furthermore, the Resident’s coverage may be subject to co-insurance, deductibles and/or co-payments which will be the Resident’s responsibility and billed according to the Resident terms for using such nonparticipating providersprivate payment stated above. In the event of denial of payment by a third-party payor, exhaustion of benefits and/or termination of coverage, the Resident, Designated Representative and/or Sponsor shall be responsible (in accordance with the terms and provisions of this Agreement) for payment to the Facility as described in the “Private Pay” section above and in accordance with applicable law.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment of his or her care will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan set forth in the written financial agreement with the Facility and the Facilitythird party insurer or managed care payor. Residents who are members of a managed care benefit plan that has is under a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services that are not included in the list of covered services under his or her plan and for applicable copayments, coinsurance and/or co-pays and deductibles. If the Resident is covered by a private insurance plan or under a managed care benefit plan that does not have a contract with the Facility, and where the insurance proceeds under the private insurance or managed care plan reimbursement is are insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. difference. The Facility will bill the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff staff, the business office and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating non-participating provider with the understanding and agreement that there the Resident will be responsible for the additional charges, if any, as a result of using such non-participating providers. Alternate Physician or Professional Provider of Service: The Resident and/or Designated Representative and/or Sponsor agree that if the physician or any other professional provider of service designated by the Resident and/or Designated Representative and/or Sponsor is not available to serve the Resident, fails to serve the Resident, or fails to comply with any applicable provision of federal or state law, the Facility is authorized to obtain the services Admission Agreement (7/2015) of a substitute physician or professional provider of service. Payment for such services will be made in accordance with this Agreement. The Resident is responsible for timely advising the Facility of what benefits, if any, may be additional charges available from his or her private insurance and/or managed care plan. Charges may be assessed above the covered benefit for skilled nursing facility care depending on the insurance coverage, managed care plan and/or written agreement with the Facility. Furthermore, the Resident’s coverage may be subject to co-insurance, deductibles and/or co-payments which will be the Resident’s responsibility and billed according to the Resident terms for using such nonparticipating providersprivate payment stated above. In the event of denial of payment by a third-party payor, exhaustion of benefits and/or termination of coverage, the Resident, Designated Representative and/or Sponsor shall be responsible (in accordance with the terms and provisions of this Agreement) for payment to the Facility as described in the “Private Pay” section above and in accordance with applicable law.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment of his or her care will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan set forth in the written financial agreement with the Facility and the Facilitythird party insurer or managed care payor. Residents who are members of a managed care benefit plan that has is under a contract with the Facility to provide specified services to plan members will have such services covered as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, he or she will be financially responsible only for payment for those services that are not included in the list of covered services under his or her plan and for applicable copayments, coinsurance and/or co-pays and deductibles. If the Resident is covered by a private insurance plan or under a managed care benefit plan that does not have a contract with the Facility, and where the insurance proceeds under the private insurance or managed care plan reimbursement is are insufficient to cover the cost of care, the Resident will be responsible for any difference in accordance with federal and State laws and regulations.. difference. The Facility will bill xxxx the Resident for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work staff staff, the business office and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating non-participating provider with the understanding and agreement that there the Resident will be responsible for the additional charges, if any, as a result of using such non-participating providers. Alternate Physician or Professional Provider of Service: The Resident and Responsible Party agree that if the physician or any other professional provider of service designated by the Resident or Responsible party is not available to serve the Resident, fails to serve the Resident, or fails to comply with any applicable provision of federal or state law, the Facility is authorized to obtain the services of a substitute physician or professional provider of service. Payment for such services will be made in accordance with this Agreement. Admission Agreement (7/2015) The Resident is responsible for timely advising the Facility of what benefits, if any, may be additional charges available from his or her private insurance and/or managed care plan. Charges may be assessed above the covered benefit for skilled nursing facility care depending on the insurance coverage, managed care plan and/or written agreement with the Facility. Furthermore, the Resident’s coverage may be subject to co-insurance, deductibles and/or co-payments which will be the Resident’s responsibility and billed according to the Resident terms for using such nonparticipating providersprivate payment stated above. In the event of denial of payment by a third-party payor, exhaustion of benefits and/or termination of coverage, the Resident, Designated Representative and/or Sponsor shall be responsible (in accordance with the terms and provisions of this Agreement) for payment to the Facility as described in the “Private Pay” section above and in accordance with applicable law.

Third Party Private Insurance and Managed Care. If the Resident is covered by a private insurance plan or under a managed care benefit plan that has a contract with the Facility, payment of his or her care will be according to the rates for coverage of skilled nursing facility benefits agreed upon by such plan set forth in the written financial agreement with the Facility and the Facilitythird party insurer or managed care payor. Residents who are members of a managed care benefit plan that has is under a contract with the Facility to provide specified services to plan members will have such receive those services covered with full coverage as long as the Resident meets the eligibility requirements of the managed care benefit plan. To the extent the Resident meets the eligibility requirements of the managed care benefit plan, ; he or she (and/or the Resident’s Spouse, Financial Sponsor and/or Designated Representative, as applicable) will be financially responsible only for payment for those services that are not included in the list of covered services under his or her plan and for applicable copayments, coinsurance and/or and deductibles. If the Resident is covered by a private insurance plan or under a managed care benefit plan that does not have a contract with the Facility, and where the insurance proceeds under the private insurance or managed care plan reimbursement is are insufficient to cover the cost of care, the Resident (and/or the Resident’s Spouse, Financial Sponsor and/or Designated Representative, as applicable) will be responsible for any difference in accordance with federal and State laws and regulations.. difference. The Facility will bill the Resident (and/or the Resident’s Spouse, Financial Sponsor and/or Designated Representative, as applicable) for any such difference on a monthly basis as described in the “Private Payment” section above above. The coverage requirements for nursing home care vary depending on the terms of the insurance or managed care plan. Questions regarding private insurance and managed care coverage should be directed to the social work business office staff and/or the Resident’s insurance or managed care plan, carrier or agent. The Resident, Sponsor and/or Resident Representative shall notify the Facility immediately of any change in Resident's insurance status or coverage including, but not limited to, ineligibility, termination, discontinuation of coverage, and/or any decrease or increase in benefits. If the Resident is covered by a private insurance plan or under a managed care benefit plan for either all or a portion of the Facility’s charges pursuant to the terms of the Resident’s plan, by execution of this Agreement the Resident hereby authorizes the Facility to utilize participating physicians and providers of ancillary services or supplies, if required by the plan for full benefit coverage, unless the Resident specifically requests a nonparticipating non-participating provider with the understanding that there may be additional charges to the Resident (and/or the Resident’s Spouse, Financial Sponsor and/or Designated Representative, as applicable) for using such nonparticipating non-participating providers. NOTE: The Resident is responsible for timely advising the Facility of what benefits, if any, may be available from his or her private insurance and/or managed care plan. Charges may be assessed above the covered benefit for skilled nursing facility care depending on the insurance coverage, managed care plan and/or written agreement with the Facility. Furthermore, Resident’s coverage may be subject to co-insurance, deductibles and/or co-payments which will be the Resident’s (and/or the Resident’s Spouse, Financial Sponsor and/or Designated Representative, as applicable) responsibility and billed according to the terms for private payment stated above.