If you are filing a claim for the first time we will need a completed application for benefits packet (Claim Form), which includes information from you, your doctor, and the facility or provider.
Patient's Claim Form, completed in full and signed by you or your representative. If your representative completes and signs the form, please attach a copy of the appointment.
From your healthcare practitioner (doctor):
Physician's Claim From completed in full and signed by a licensed healthcare practitioner.
From the facility, if you are claiming facility benefits (nursing home, assisted living):
Provider Claim Form completed in full by your facility. The facility is asked to attach documents supporting the Proof of Loss. These are highlighted on the form.
Please note: Each long term care policy varies in coverage and benefits and policies by state. Be sure that you clearly understand what the benefit triggers are under you policy and the facility/provider requirements. Please contact our customer service department if you have any questions concerning your policy.