First Time Claims

At Senior Health Insurance Company of Pennsylvania (In Rehabilitation) ("SHIP"), we understand that filing a new long-term care insurance claim can be confusing. To provide clarity in filing a new claim, the claim information package is designed to provide you with straightforward instructions on how to file a claim under your Senior Health Insurance Company of Pennsylvania (In Rehabilitation) long term care policy.

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Nursing Home:

When preparing to submit a claim toward your long-term care insurance policy, please refer to your actual policy to help determine the type of coverage you have. In order for an eligibility determination to be completed the following documents are typically required to substantiate Proof of Loss for an insured confined to a nursing home:

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• Patient's Claim Form

• Itemized Bill(s)

• Facility License

• Minimum Data Set (MDS), if facility has assessment tool

• Initial Admission Assessment, if facility does not have an MDS.

• Continued Monthly Resident (CMR) Form

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Some or all of the following documents may be required to substantiate Proof of Loss for an insured confined in a nursing home. The requirements may vary dependent upon several factors such as, but not limited to, the claimant's primary diagnosis and other medical conditions. The following information may be requested by our claims department to assist in the eligibility determination process.

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• Physician's Claim Form (part of the claim form used to submit the Proof of Loss that should be completed by your attending physician.)

• Provider's Claim Form (part of the claim form used to submit the Proof of Loss that should be completed by the director of the facility in which you are confined.)

• Admission Notes (information used to determine your level of care needs completed when you were admitted to the facility.)

• Benefit Eligibility Assessment (a face-to-face assessment of your care needs, performed by a registered nurse (R.N.) at the company's expense.)

• Physician's Cognitive Questionnaire (a standardized questionnaire sent by our claims department to your attending physician to assist in determining your level of care needs)

• Medical Records (any additional information that may be needed to substantiate your level of care needs.)

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Assisted Living Facility

When preparing to submit a claim toward your long-term care insurance policy, please refer to your actual policy to help determine the type of coverage you have. In order for an eligibility determination to be completed the following documents are typically required to substantiate Proof of Loss for an insured whose primary residence is an assisted living facility:

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• Patient's Claim Form

• Itemized Bill(s)

• Initial Admission Assessment, if available

• Facility's Service Plan, if available

• Facility's License

• Continued Monthly Resident (CMR) Form

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Some or all of the following documents may be required to substantiate Proof of Loss for an insured whose primary residence is an assisted living facility. The requirements may vary dependent upon several factors such as, but not limited to, the claimant's primary diagnosis and other medical conditions. The following information may be requested by our claims department to assist in the eligibility determination process:

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• Physician's Claim Form (part of the claim form used to submit the Proof of Loss that should be completed by your attending physician.)

• Provider's Claim Form (part of the claim form used to submit the Proof of Loss that should be completed by the director of the facility in which you are confined.)

• Benefit Eligibility Assessment (a face-to-face assessment of your care needs, performed by a registered nurse (R.N.) at the company's expense.)

• Physician's Cognitive Questionnaire (a standardized questionnaire sent by our claims department to your attending physician to assist in determining your level of care needs)

• Medical Records (any additional information that may be needed to substantiate your level of care needs.)

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Home Health Care

These documents are typically required to substantiate Proof of Loss for a claimant receiving or needing home health care:

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• Patient's Claim Form

• Itemized Bill(s)

• Caregiver notes, documenting the daily type, level and frequency of care performed

• Individual's Certification or Agency's License, if available and dependent on policy language

• Agency's Service Plan/Plan of Care, if available

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Some or all of the following documents may be required to substantiate Proof of Loss for an insured who is receiving or needing home health care. The requirements may vary dependent upon several factors such as, but not limited to, the claimant's primary diagnosis and other medical conditions. The following information may be requested by our claims department to assist in the eligibility determination process:

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• Physician's Claim Form (part of the claim form used to submit the Proof of Loss that should be completed by your attending physician.)

• Provider's Claim Form (part of the claim form used to submit the Proof of Loss that should be completed by the agency or provider of your care.)

• Benefit Eligibility Assessment (a face-to-face assessment of your care needs, performed by a registered nurse (R.N.) at the company's expense.)

• Physician's Cognitive Questionnaire (a standardized questionnaire sent by our claims department to your attending physician to assist in determining your level of care needs)

• Medical Records (any additional information that may be needed to substantiate your level of care needs.)

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Other Services (i.e., Adult Day Care, Hospice, Respite, etc.)

These documents are typically required to substantiate Proof of Loss for an insured who files a claim under the policy for ancillary or limited services:

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• Patient's Claim Form

• Itemized Bill(s)

• Provider's License or Certification, dependent on policy language.

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Some or all of the following documents may be required to substantiate Proof of Loss for an insured who files a claim under the policy for ancillary or limited services. The following information may be requested by our claims department to assist in the eligibility determination process:

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• Physician's Claim Form (part of the claim form used to submit the Proof of Loss that should be completed by your attending physician.)

• Provider's Claim Form (part of the claim form used to submit the Proof of Loss that should be completed by the provider of your care.) 

• Admission Notes (information used to determine your level of care needs completed by the provider of your care.)

• Benefit Eligibility Assessment (a face-to-face assessment of your care needs, performed by a registered nurse (R.N.) at the company's expense.)

• Physician's Cognitive Questionnaire (a standardized questionnaire sent by our claims department to your attending physician to assist in determining your level of care needs)

• Medical Records (any additional information that may be needed to substantiate your level of care needs.)

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