LTC Eligibility Review Process

LTC Eligibility Review Process

Genworth Guide to Making a Claim

A team will be assigned to evaluate your claim. The team will work with you, or your personal representative, and care providers, to gather all required documentation, which may include, among possible others:

  • Functional Assessment Interview
  • Authorization to Release Information

During the eligibility review process, our team will evaluate the type(s) of Long Term Care (LTC) Benefits you wish to access and the policy or certificate's coverage limits. This team may also consider your medical records, assessment interviews and provider information.

Genworth will make a claims decision after receiving all the required information needed to complete the evaluation process. If additional information is needed, you will receive periodic communication outlining the remaining documentation required to complete the review.

You can help the eligibility review by ensuring Genworth has complete and current information for the insured and/or the authorized representative for the claim (i.e. mailing address and phone number), and by being available for questions.

After reaching a benefit eligibility determination, a member of the team will contact you, or your personal representative, by letter or telephone to discuss the decision made and to answer any related questions.

Please note: Active claims may require additional ongoing eligibility evaluations. The claimant and/or provider may periodically be evaluated to ensure that the benefit eligibility requirements are still being met. These reevaluations are based on policy type, policy form and the state which issued the original policy.

For more information on the Initial Assessment procedure, please click here.

206401E1C3 11/09/22