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Submitting Claims 

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.

From you:

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 a 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 your policy and the facility/provider requirements. Please contact our
customer service department if you have any questions concerning your policy.

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