Long Term Care Insurance FAQ

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Initiating a claim

Q. When should a claim for long term care insurance benefits be initiated?
A. The Insured or his or her representative should contact us as soon as long term care services are required or are being received.

Q. How is a claim for long term care insurance benefits initiated?
A. A claim can be initiated by anyone calling us. It is necessary to have the Insured's identifying information to begin the claims process. Our Claims Customer Service Representatives will be happy to clarify policy benefits and explain the claim process, although some privacy regulations may apply. 

Claims service 
800 876.4582 
Monday – Thursday 8:30 AM – 8 PM ET and Friday 9AM – 8PM ET

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Benefit eligibility

Q. What claim forms are required?
A. Required forms include statements from the Insured, the attending physician, and the long term care provider. If the policy provides for reimbursement of expenses incurred for long term care, bills or invoices and acceptable proofs of payment will be required. All necessary claim forms will be sent directly to the Insured at his or her requested address.

Q. Who completes the claim form?
A. We request that the Insured or his or her designated legal representative sign the HIPAA compliant Heath Information Authorization and the Insured's Statement. If the Insured is unable to sign these forms and is being assisted by someone who is not his or her designated legal representative, that person can contact us toll free for guidance on how to proceed. 

Claims service 
800 876.4582 
Monday – Thursday 8:30 AM – 8 PM ET and Friday 9AM – 8PM ET

Q. Where should the completed claim forms and proofs of payment be sent?
A. Claim forms, invoices and any other requested documents should be sent to: 

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

Fax number 
888 557.5526

Q. Who will review the claim?
A. Each claim is assigned to a Benefit Analyst who will work directly with the Insured or his or her representative to complete the claim process. A Benefit Analyst is a professional trained to adjudicate long term care insurance claims.

Q. Once a claim is filed, how quickly will there be a written reply?
A. Each claim is unique and the time it takes to make a benefit determination may vary. We will communicate regularly throughout the process with the Insured or his or her representative.

Q. Is there any information, other than claim forms, needed to make a claim determination?
A. There may be. Once we receive completed claim forms, it may be necessary for us to obtain additional documentation to make an accurate determination of eligibility for benefits. The additional documentation may include but is not limited to physician and hospital records and care provider notes.

Q. When am I eligible for long term care insurance benefits?
A. Each long term care insurance policy specifies the conditions under which benefits are payable. A Claims Customer Service Representative can discuss the requirements of the Insured’s policy and help the Insured or his or her representative understand the conditions under which benefits are payable.

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Elimination period

Q. What is an elimination period/deductible period?
A. The elimination period is a specific number of days during which the Insured is eligible for benefits but for which no long term care insurance benefits will be paid by the insurance company. Some policies do not have elimination periods or the elimination period may apply only to specified benefits.

Q. Must I satisfy an elimination period or deductible period before I file a long term care insurance claim?
A. No, you are not required to satisfy an elimination period or deductible period prior to filing a long term care claim. Long term care insurance claims should be filed as soon as the Insured begins receiving long term care services.

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Privileged Care Coordination Services

Q. What are Privileged Care Coordination® Services?
A. Some, not all, policies provide for the services of a Privileged Care Coordinator. This Coordinator is a Registered Nurse who, among other things, can assist the insured with finding appropriate care services from local Home Care Agencies, if needed. The Coordinator is assisted by Registered Nurses who work in or near the Insured’s hometown.

Q. How can the Privileged Care Coordination Services be accessed?
A. After the intake call is complete, the Intake Analyst initiates the care coordination process. Insureds filing a claim for Home Care Benefits will receive an in-home assessment and Plan of Care as a part of this process. On-going services are also provided once the claim is approved. Insureds filing a claim for Assisted Living Facility Benefits will receive an in-facility assessment as a part of this process. If you need help identifying facility care providers please contact us toll free: 

Claims service 
800 876.4582 
Monday – Thursday 8:30 AM – 8 PM ET and Friday 9AM – 8PM ET

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Contact information

Q. Who can answer questions or concerns about the status of a claim or the claim process?
A. If you have questions regarding a claim, please contact us toll free:

Claims service 
800 876.4582 
Monday – Thursday 8:30 AM – 8 PM ET and Friday 9AM – 8PM ET

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Appeals

Q. If the Insured disagrees with the claim decision, how can that decision be appealed?
A. The Insured or his or her designated legal representative can appeal the claim decision by sending a written request to the Genworth Claim Services Department: 

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

The request to review the claim should include any additional information that may assist us with our determination. A claims specialist will review the claim and the additional information provided and will notify the Insured, in writing, of our decision within 60 days of receiving the appeal. If special circumstances require additional time for our review, the Insured will be notified. 

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142283LTFAQ 08/16/12