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Common Questions

How can I report fraudulent activity regarding a Senior Health Insurance Company of Pennsylvania policy?

Please call 888-387-5824, complete the online form here Fraudulent Activity Referral Form or write to:

Senior Health Insurance Company of Pennsylvania
P.O. Box 64913
St. Paul, MN 55164

What is a Third Party Designee?

A third party designee is a person of your choosing that we will notify if your policy is in jeopardy of lapsing due to nonpayment of premium.

What is needed to make an address or phone number change?

You may simply call customer service to update your address or phone number. You may also submit a signed written request to our office.

How do I file a claim for the first time?

If you are filing a claim for the first time we will need a completed application for benefits packet, which includes information from you, your doctor, and the facility or provider. You can find more information on submitting forms here.

What do I need for ongoing claims?

For ongoing services to be considered please submit continued proof of loss. You can find more information about ongoing claims by contacting customer service here.

What is my Alternative/Alternate Plan of Care (APOC) benefit?

Each request for benefits under an Alternate Plan of Care (APOC) rider will be considered against both the language of the policy and the unique circumstances of the case. Senior Health Insurance Company of Pennsylvania employs standardized protocols to ensure all requests for APOC benefits are handled consistently according to the terms and conditions of the policy language. Senior Health Insurance Company of Pennsylvania may utilize tools such as on-site benefit eligibility assessments to determine if the benefit eligibility requirements set forth in the policy have been satisfied. Once the eligibility requirements have been established, Senior Health Insurance Company of Pennsylvania will contact the attending physician to obtain documentation describing the medically necessary alternative care recommendation, the proposed care plan as well as the reason the benefits provided in the policy are not medically sufficient.
If you have additional questions on the consideration of APOC benefits, please contact customer service.

Are my benefits good in another State?

Yes. As long as you meet your eligibility for benefits under your policy, you may use your policy in any State.

Why have I not received a premium notice?

Premium notices are generated 20 days before the premium due date.

Do you accept credit card payments?

Currently at this time, Senior Health Insurance Company of Pennsylvania does not accept credit card payments.

Do I have a grace period on my policy premiums?


Where do I send my premium payments?

Please send to:
Senior Health Insurance Company of Pennsylvania
Dept CH 14356
Palatine, IL 60055-4356

Is there an overnight premium payment address?

Please send to:
Senior Health Insurance Company of Pennsylvania
Attn: 14356
5505 N. Cumberland Ave.
Ste. 307
Chicago, IL 60656

Why did I receive a 1099-LTC?

Any claim payment made on a Long Term care policy over the last year receives a 1099-LTC.

What options are available to lower my policy premiums?

Senior Health Insurance Company of Pennsylvania, under the supervision of an Oversight Trust, exists solely for the benefit of policyholders. As both Senior Health Insurance Company of Pennsylvania and the Trust operate without profit, options can be offered to lower your premium. This is especially important when Senior Health Insurance Company of Pennsylvania, based on its claims experience, must raise rates, subject to regulatory approval, to protect policyholders.

As Senior Health Insurance Company of Pennsylvania is committed to providing alternatives to help you continue to afford coverage, options are available to decrease your policy premiums by reducing benefits including:

Should you be interested in receiving a benefit reduction quote for one or a combination of these benefits please contact Customer Service at (877) 450-5824.

What claim forms must be completed for every claim?

The required forms are included within the Claim Information Package. Complete the first three pages of the Claim Form. Also complete page 4, the Authorization For Disclosure of Health-Related Information, if you want to authorize anyone other than the policyholder to speak with us about your claim. Please submit all of these forms to us together. PLEASE ALSO MAKE SURE THAT ITEMIZED INVOICES ARE SUBMITTED TO US. If you are filing a Home Health Care claim, the enclosed Caregiver Weekly Timesheets may be used if your provider does not supply them.

Is there any information, other than claim forms, needed to make a claim determination?

Once we receive completed claim forms, it may be necessary for us to obtain additional documentation to make an accurate determination of eligibility for benefits. The additional documentation may include, but is not limited to, physician and hospital records, the provider’s license (if applicable) and care provider notes. In all cases itemized bills must be submitted to us for benefits to be provided. It is very important to make copies of all correspondence being sent in to file the claim so that you have a record of what you have submitted. Please refer to the appropriate enclosed initial claim checklist for detailed guidance on completing the claim forms, as well as, the additional documentation we may need.

Who completes the claim form?

We request that the policyholder or legal representative fully complete the Policyholder Claim Form and the “Authorization For Use of Health-Related Information.” The policyholder or legal representative should also complete the “Authorization for Disclosure of Health-Related Information,” if you want to authorize us to speak to anyone other than the policyholder about this claim. Be sure to return these documents to us at the same time.

What is a Continued Monthly Residence (CMR) Form?

A Continued Monthly Residence form is a required part of the monthly claim submission and must be completed thoroughly by facility staff.

What is a Direction to Pay form?

A Direction to Pay form allows us to pay your care provider directly. This is not a permanent assignment of policy benefits; you have the right to change your mind at any time in the future. This form is only required if you would like us to send any payable benefits directly to your provider. In order to assign benefits, please be advised that we will only accept the Direction to Pay form. In addition, your provider must send us a completed W-9 form (required by the IRS).

Where can I get more claim forms?

More claim forms can be downloaded here; or you can call our Customer Service team to obtain forms through the mail.

Who can answer questions or concerns about the status of a claim or the claim process?

Our Customer Service Representatives will be happy to clarify policy benefits and explain the claim process, although some privacy regulations may apply. If you have questions regarding a claim, please contact us at the telephone number listed on the bottom of each claim form.

Where should I send the completed claim forms?

Our mailing address and fax number are located on the bottom of each claim form and on the initial claim checklist.