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Friday 9:00 am - 8:00 pm ET
Fax your documents to 888 557.5526
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
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.
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).
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.
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.
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.
No. A claim should be initiated immediately once the Insured begins, or is ready to begin, receiving care or services.
Genworth usually makes a claim decision within 30 to 45 days of receiving all required information needed to complete the evaluation process.
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.
It depends. Additional documentation may be necessary to make an accurate determination of benefit eligibility, which may include, among possible others:
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
Each claim is assigned to a trained Long Term Care Benefit Analyst.
Facilities must meet specific requirements and therefore, each facility must be evaluated individually to determine if the policy or certificate requirements are satisfied.
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.
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.
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.
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:
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.
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.
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.
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.
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.
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.
Yes. Genworth will mail an Explanation of Benefits to the Insured Person, or the Insured person’s legal representative, with each benefit payment issued.
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.
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.
To request a claim closure, the Insured person should call 800.876.4582.
To report an Insured person’s death call 800.876.4582.
Any remaining benefits are generally paid to the Insured person’s Estate.
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.