At Senior Health Insurance Company of Pennsylvania (In Rehabilitation) ("SHIP"), we understand that filing a long-term care insurance claim for home health care benefits can be confusing. The information on this page is designed to provide straightforward instructions for filing a claim for home health care benefits.
Please be sure to read the policy very carefully, with special attention to benefit eligibility requirements, current benefits for each policy feature, and the provider requirements. If you have any questions, please contact our customer service department at (877) 450-5824.
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​Claim Form, signed, and dated by the policyholder or their representative.
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Complete questions 1 – 14.
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If a legal representative completes and signs the form, please attach a copy of the documentation granting legal authority.
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Authorization for Use of Health-Related Information Form
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Authorization for Disclosure of Health-Related Information Form, if you would like our representatives to be able to speak to someone other than the policyholder about care
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Other documents contained in the Claim Information Packet that apply to your situation
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Invoices or billing statements (can be submitted by either the policyholder or the provider)
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Caregiver Weekly Timesheet or Caregiver notes, documenting the daily type, level and frequency of care performed (can be submitted by either the policyholder or the provider)
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Direction to Pay Form (required if directing benefit payments to provider)
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Eligible benefits will be paid upon receipt of appropriate forms and valid documentation, including invoices or billing statements
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Important Reminder: Please make copies of all claim forms and documentation and retain for your records!