Filing a Claim
If you are filing a new claim we will need a completed Claim Form, a completed Authorization for Use of Health-Related
Information Form and any other documents contained in the Claim Information Packet that apply to your situation.
Claim Form, completed in full, signed and dated by you or your representative. If your representative completes and
signs the form, please attach a copy of the appointment.
Invoices or billing statements submitted by either you, your caregiver, or your facility. No benefits can be paid until a valid
proof of loss (invoice or billing statement) is received by us.
From your healthcare practitioner (doctor):
Any necessary medical information will be requested by us from your licensed healthcare practitioner.
From the facility, if you are claiming facility benefits (nursing home, assisted living):
Any necessary facility information will be requested by us from your facility.
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.