To file a long term care insurance claim and begin coverage, the policyholder must be certified as a person needing substantial assistance with at least two of six daily living activities (eating, bathing, dressing, toileting, continence and transferring). Or, be verified as a person having a cognitive impairment and is a danger to themselves or others. The condition must be believed to last at least 90 days or longer.
How to File a Long Term Care Insurance Claim
Step 1: The policyholder or a member of their support team contacts the insurance carrier to obtain a claim form (the telephone number of the carrier is typically listed on the first page of the policy).
If the caller is not the policyholder, the support person must usually provide:
- A power of attorney
- The policy number
- The policyholder’s current address and four consecutive digits of their social security number
To determine the initial benefit eligibility of the policyholder, the carrier may then contact:
- The facility where the policyholder resides to collect clinical details about his or her functional status
- The policyholder to arrange a visit to assess his or her functional status
- The policyholder’s care provider for more information
Step 2: The carrier determines if the policyholder’s care provider meets the policy requirements and notifies the policyholder in writing.
Step 3: Before benefits are paid, the elimination period must be satisfied. The elimination period is the number of days the policyholder must pay for service while remaining eligible for benefits, similar to a deductible.
Step 4: The policyholder, or a member of their support team, must submit written invoices for covered services in order to receive policy benefits, often on a monthly basis. The policyholder may choose to have the carrier pay all approved long term care expenses directly to the service provider or be reimbursed for qualifying expenses they pay themselves.
Step 5: The carrier will review the Long Term Care Insurance claim periodically to ensure the policyholder remains eligible for benefits.
Do you have a long term care plan for your future? Use our online quote tool to learn how much long term care coverage would cost for you.
The information provided is not exhaustive and is intended to provide the general framework for processing a typical long term care claim only.