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Friday 9 AM - 6 PM ET
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USPS Mailing Address
Long Term Care Claims
P.O. Box 40007
Lynchburg, VA 24506-9939
FedEx and UPS Mailing Address
Long Term Care Claims
3100 Albert Lankford Drive
Lynchburg, VA 24501-5822
Frequently Asked Long Term Care Questions
Filing a ClaimBack to top
Q. How can you initiate a claim?
Q. Do you need a Power of Attorney?
No. However, your personal claim information (health and financial) is accessible only by designated legal representatives, unless otherwise granted (see immediately below).
Q. How can another individual access your claim information?
You, or your legal representative, may complete a Genworth Authorization to Release Information form. However, the individual(s) you name may not direct the handling of your claim or access your online claim information.
Policy or Certificate Coverage
Q. What types of services does your policy or certificate cover?
It varies by the type of coverage purchased. Policies or certificates may provide coverage for care or services received in a nursing home, an assisted living facility, or in a home or alternate care setting. For specific coverage, a review of your policy or certificate is necessary.
Initiating a Long Term Care Claim
Q. Are you required to satisfy your policy or certificate’s Elimination Period before initiating your claim?
No. A claim should be initiated as soon as you begin, or are within two weeks of, receiving care or services.
Q. What is the time frame for Claims to reach an eligibility determination?
Genworth usually makes a claim decision within 30 days of receiving all required information needed to complete the evaluation process.
Q. What claim forms are you or your legal representative required to complete?
Authorization to Release Information
Q. What information may be requested from your care provider?
It depends. Additional documentation may be necessary to make an accurate determination of benefit eligibility, which may include, among possible others:
- Medical Records
- Hospital Records
- Facility Records
- Billing Invoices and provider care notes
Q. How should claim forms be submitted to Genworth?
Claim forms and any requested information may be mailed or faxed to Genworth. All information must include the assigned claim number and your full name.
Genworth Long Term Care Claims
P. O. Box 40007
Lynchburg, VA 24506-9939
The Claim Review ProcessBack to top
Q. Who will review the claim to determine your benefit eligibility?
Each claim is assigned to a trained Long Term Care Claim Associate.
Q. Are all facilities covered by your policy or certificate?
Facilities must meet specific requirements and therefore, each facility must be evaluated individually to determine if the policy or certificate requirements are satisfied.
Q. How do you know if a facility is covered?
You, or your representative, may contact Genworth, before moving to a facility, to ask that a facility be reviewed for satisfaction of the policy or certificate’s specific requirements.
Q. What happens after a decision has been made on your claim?
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.
Q. Can you receive Long Term Care services before a claim decision is made?
Yes. However, if it is determined that the services are not covered under the policy or certificate, or that an Elimination or Deductible Period must be satisfied prior to services being covered, you would be fully responsible for the expenses incurred.
Plan of CareBack to top
Q. What are Privileged Care Coordination® Services?
Some policies and certificates include the option of using Privileged Care Coordination® Services, provided by either a registered nurse or social worker, employed by an agency that has been designated by Genworth.
When a claim is opened, a Privileged Care Coordinator will contact you, or your personal representative, to schedule an initial assessment with an assessing nurse.
The Privileged Care Coordinator will then work with the assessing nurse to develop your personalized Plan of Care for you and, depending upon your care needs and policy or certificate’s eligibility requirements, may also provide a Chronically Ill Certification.
Based on your specific policy or certificate, Privileged Care Coordination® Services may include:
- A comprehensive face-to-face assessment to identify your care needs;
- Identifying and providing care providers in your area;
- Contacting up to three home care agencies in your area to confirm their ability to provide the type of care required, and to negotiate a rate for their services; and
- Scheduling and coordinating care and support services if an agency from those suggested is chosen.
Please note: Depending on the coverage purchased by you, the Home Care Benefit may require a Plan of Care developed by a Privileged Care Coordinator or payment of some or all of the charges incurred for Privileged Care Coordination® Services from the policy benefits. For specific details regarding the requirements of the policy, contact a Policy Holder Services representatives at 800.456.7766, or if you have a current claim opened, please contact Genworth Claims at 800.876.4582.
Benefit Payment ProcessBack to top
Q. Are billing statements required when requesting Long Term Care coverage?
It depends. Billing statements are generally required for all services or items that are considered for reimbursement under a Long Term Care Reimbursement policy or certificate, as well as services that are considered under an Indemnity policy’s Home and Community Care Rider, if purchased by you.
Q. If approved for benefits, when will you begin receiving benefit payments?
After the policy or certificate’s Elimination Period, if applicable, has been met, and while you remain benefit eligible, benefit payments for covered care will begin. The initial benefit payment is usually processed within 30 business days following satisfaction of the Elimination Period.
Q. If you received care prior to initiating a claim will those expenses be paid?
It depends. Benefits payments are issued based on the specific provisions of your policy or certificate. Therefore, among other things, a full review of your care needs, at the time services were received, must be completed before an eligibility decision can be determined. The policy or certificate may also specify certain timely filing requirements.
Q. How will you receive benefit payments?
Benefit payments are typically mailed to you in the form of a check. However, Genworth may electronically issue benefit payments into a bank account - designated in an acceptable Electronic Benefit Payment form - that names you as an account holder.
Q. Will Genworth pay a care provider directly for covered care?
Benefit payments are typically paid directly you. However, Genworth may issue benefit payments to certain care providers designated by an acceptable Assignment of Benefits.
Q. Will an Explanation of Benefits be provided with each benefit payment?
Yes. Genworth will mail an Explanation of Benefits to you with each benefit payment issued.
Q. If the claim is approved, can you stop paying premiums?
It depends. Waiver of Premium may not be effective immediately, may not be available with all policies, certificates, or benefits, and may have state-specific requirements if available. It may also depend on your required Elimination Period, and whether or not any payments have been made. For specific Waiver of Premium information, a review of your purchased policy or certificate is necessary.
Care Level ChangesBack to top
Q. If approved for benefits, can you later change care providers?
Yes. However, to avoid delays, you, or your personal representative, should call Genworth as soon as it is known that a change in care level is expected. A new eligibility may be required for benefits to continue.
Closing a ClaimBack to top
Q. How would you close a claim if Long Term Care services are no longer needed?
To request a claim closure, you should call 800.876.4582.
Q. After an Insured person’s death, who should be notified?
To report an Insured person’s death call 800.876.4582.
Q. After the Insured person’s death, who receives the final payment for covered expenses that are due and owed.
Any remaining benefits are generally paid to the Insured’s Estate.
Q. After the Insured person’s death, will the policy or certificate’s maximum balance be paid to the Insured’s beneficiary?
No. At the time of death, beneficiaries are not entitled to any Long term care insurance policy or certificate’s remaining maximum balance, other than any amounts for eligible care which have not yet been reviewed and paid.