Change in Care
When your level of care changes (e.g. a move from a facility to home, home to a facility, or a change in care levels from skilled nursing to assisted living or vice-versa), a full benefit eligibility review must be completed to determine if you continue to satisfy the eligibility requirements of the Long Term Care (LTC) policy or certificate.
You or your personal representative should call Genworth Long Term Care Claims at 800.876.4582 as soon as it is known that a change in care level is expected to avoid delays. This call will ensure that Genworth is made aware of the change in your care, which will initiate the eligibility review process.
Upon contacting Genworth at the number above, the Customer Service Representative will obtain the necessary information related to your new location and care needs. The claim associate will request any required information needed to complete the review, which may include:
- Onsite Functional Assessment Interview
- Provider information
Genworth usually makes a claim decision within 30 days of receiving all required information needed to complete the evaluation process. However, if the claim associate is unable to reach a decision, or if additional information is needed, you will receive periodic communication outlining the remaining information required to complete the review.
You can help the eligibility review by ensuring Genworth has complete and current information, and by being available for questions.
After reaching a benefit eligibility determination, the claim associate will contact you, or your personal representative, by letter or telephone to discuss the decision made and to answer any related questions.