A Genworth Guide to Making a Claim

FAQs

Contact LTC Claims: 800 876.4582

Hours

Monday - Thursday 8:30 am - 8:00 pm
Friday 9:00 am - 8:00 pm ET

Fax Number

Fax your documents to 888 557.5526

USPS Mailing Address

Genworth Financial
Long Term Care Claims
P.O. Box 40007
Lynchburg, VA 24506-9939

FedEx and UPS Mailing Address

Genworth Financial
Long Term Care Claims
3100 Albert Lankford Drive
Lynchburg, VA 24501-5822

How to File a Claim

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Q. Who can initiate a claim?

Anyone may start a claim on behalf of an Insured. The individual will need the Insured person’s full name, social security number, date of birth, and policy or certificate number available.

Q. Does the Insured person need a Power of Attorney?

An Insured person is not required to have a Power of Attorney. However, the Insured person’s personal claim information (health and financial) is accessible only by designated legal representatives, unless otherwise granted (see immediately below).

Q. How may an individual be granted access to the Insured person’s claim information without a Power of Attorney, or court document?

By completing an Authorization to Release Information form, the Insured person or Insured’s legal representative may grant another individual access to Protected Health Information (PHI). However, the individual may not direct the handling of the Insured person’s claim.

Policy or Certificate Coverage

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Q. What types of services does the Insured person’s 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 the Insured person’s purchased policy or certificate is necessary.

Initiating a Long Term Care Claim

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Q. How is a claim for Long Term Care Benefits initiated?

Call Genworth Long Term Care Claims, during the hours below, at 800.876.4582. Please have the Insured person’s full name, social security number, date of birth, and policy or certificate number available.

  • Monday through Thursday, 8:30 a.m. to 8:00 p.m. EST
  • Friday, 9:00 a.m. to 8:00 p.m. EST

Q. Is the Insured person required to satisfy the policy or certificate’s Elimination or Deductible Period before initiating a Long Term Care claim?

No. A claim should be initiated immediately once the Insured begins, or is ready to begin, 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 to 45 days of receiving all required information needed to complete the evaluation process.

Q. Who completes the claim forms?

The Insured person or Insured’s legal representative will usually complete some of the required claim forms, while others are completed by care providers and physicians.

Q. What claim forms are the Insured person or Insured’s legal representative required to complete?

  • Authorization To Release Information
  • Insureds Statement

Q. What information may be requested from the Insured person’s care provider?

It depends. Additional documentation may be necessary to make an accurate determination of benefit eligibility, which may include, among possible others:

  • Attending Physician’s Statement
  • Medical Records
  • Hospital Records
  • Facility Records
  • Billing Invoices and provider care notes
Please note: Other information may be required in order to complete a review of the Insured person’s care provider, if required by the policy or certificate. Genworth will generally request any necessary additional documentation directly from the Insured person’s care provider, when required.

Q. How should claim forms be submitted to Genworth?

Claim forms and any requested information may be mailed or faxed to Genworth.

Genworth Long Term Care Claims
P. O. Box 40007
Lynchburg, VA 24506-9939
Fax: 888.557.5526

The Claim Review Process

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Q. Who will review the claim to determine the Insured person’s benefit eligibility?

Each claim is assigned to a trained Long Term Care Benefit Analyst.

Q. Are all facilities covered by the Insured person’s 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 does the Insured person know if a facility is covered?

The Insured person, or the Insured person's 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 the Insured person’s claim?

After reaching a benefit eligibility determination, the Benefit Analyst will contact the Insured person, or the Insured’s personal representative, by letter and telephone to discuss the decision made, and to answer any related questions.

Q. Can the Insured person 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, the Insured person would be fully responsible for the expenses incurred.

Plan of Care

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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 the Insured person, or the Insured’s personal representative, to schedule an initial assessment with an assessing nurse.

The Privileged Care Coordinator will then work with the assessing nurse to develop a personalized Plan of Care for the Insured person and, depending upon the Insured person’s care needs and policy or certificate’s eligibility requirements, may also provide a Chronically Ill Certification.

Based on the Insured person’s specific policy or certificate, Privileged Care Coordination® Services may include:

  • A comprehensive face-to-face assessment to identify the Insured person’s care needs;
  • Identifying and providing care providers in the Insured person’s area;
  • Contacting up to three home care agencies in the Insured person’s 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 the Insured person, 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 the Insured person has a current claim opened or wishes to open a claim, please contact Genworth Claims at 800.876.4582.

Benefit Payment Process

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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 the Insured person.

Q. If approved for benefits, when will the Insured person begin receiving benefit payments?

After the policy or certificate’s Elimination Period, if applicable, has been met, and while the Insured person remains 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 the Insured person was receiving care prior to initiating a claim will those expenses be paid?

It depends. Benefits payments are issued based on the specific provisions of the Insured person’s policy or certificate. Therefore, among other things, a full review of the Insured person’s 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 the Insured person receive benefit payments?

Benefit payments are typically mailed to the Insured person 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 the Insured person as an account holder.

Q. Will Genworth pay a care provider directly for covered care?

Benefit payments are typically paid directly to the Insured person. 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 the Insured Person, or the Insured person’s legal representative, with each benefit payment issued.

Q. If the claim is approved, can the Insured person 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 the Insured person’s required Elimination Period, and whether or not any payments have been made. For specific Waiver of Premium information, a review of the Insured person’s purchased policy or certificate is necessary.

Care Level Changes

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Q. If approved for benefits, can the Insured person later change care providers?

Yes. However, to avoid delays, the Insured person, or the Insured person’s personal representative, should call Genworth as soon as it is known that a change in care level is expected. A new review of ongoing eligibility may be required for benefits to continue.

Closing a Claim

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Q. How would an Insured person close a claim if Long Term Care services are no longer needed?

To request a claim closure, the Insured person 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 person’s Estate.

Q. After the Insured person’s death, will the policy or certificate’s maximum balance be paid to the Insured person’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.

164612FAQ 11/17/15