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BENEFITS / CLAIMS
Filing for Benefits
A long term care claim for benefits should be filed with the insurer as soon as the Insured initiates long term care services. The claims process begins with a review of the LTC contract. Next, the policy owner or designated representative should contact the insurer to open the claim. Prepare the insured or their designated representative to have the following information available when placing a benefits call:
- Full name of insured
- Date of birth
- Current mailing address of policyholder
- Specifics of claim, i.e., medical condition, care requirements, HHC or LTC facility, etc.
- Policy number
- Social Security number
Typically, the insurer assigns a benefits specialist to provide guidance to the insured or designated representative to assist with the claim for benefits.
Claim forms are sent directly from the insurer to the insured for completion and submission. Some carriers may even have claim forms available electronically on-line.
All claims information is strictly confidential. It is the final determination of the insurer whether eligibility for benefits has been certified and all requirements satisfied according to the language of the LTC contract.
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