The LTCi Claims Process in Five Steps

STEP 1:

Making Initial Contact

Often the agent is the first point of contact.

  • If the insured contacts you, notify the claims department as soon as possible
  • The insured also can contact the claims department directly. The appropriate phone number is listed in the policy

STEP 2:

Gathering Information

A claims representative will:

  • Talk with the insured to gather more information
  • Send the insured a claim form
  • Provide a list of documentation needed (i.e. medical records, provider bills)

STEP 3:

Explaining Policy Benefits

A claims representative will explain the benefits of the insured’s specific policy. This may include:

  • Elimination period
  • Care coordination services
  • Payment of benefits
  • Waiver of premium

STEP 4:

Determining Benefit Eligibility

  • It takes approximately 10 business days to review a claim and determine benefit eligibility
  • Claims notifies the insured or his or her representative when eligibility is confirmed

STEP 5:

Paying the Claim

  • It takes approximately 10 business days to approve an expense and issue a check
  • Payment is sent to the insured, to his or her representative or to an LTC service provider

Claims Resources

When a Client Goes on Claim

View a short presentation that steps through the claims process

Policyholder Guide

Give to policyholders who contact you to initiate a claim

Order printed copies through normal channels

Point-of-Sale Brochure

Show prospective clients how the policy they’re considering will work at claim time

Order printed copies through normal channels

The Role of the Agent

If you become aware of a potential claim, notify the claims department as soon as possible.

Be prepared to provide the following information:

  • Insured's name
  • Phone number
  • Mailing address
  • Email address
  • Policy number
  • Insured’s representative/power of attorney
  • Type of claim (i.e., home health care, assisted living, nursing home)

Claims Department Contacts

Contact information differs based on the type of policy, so be sure to use the correct phone number.

Policy Forms LT50, NH50, HCA, HCAQ, NHA, NHAQ, LTA, LTAQ

(policies sold from 1987 to 2004)

Phone: (800) 268-6443

Hours: M-Th: 7 a.m. to 5:30 p.m. CST
Friday: 7 a.m. to 5 p.m. CST

Policies Sold After 2004

(LTC04 and later; these policies have 33-xxxxxx numbers)

Phone: (877) 894-2478

Hours: M-F: 7 a.m. to 5 p.m. CST

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