The initial onsite assessment is a face-to-face interview conducted in the Insured person’s home or assisted living facility by an assessing nurse who will:

  • Observe the Insured person’s ability to perform Activities of Daily Living.
  • Conduct a functional assessment to evaluate the Insured person’s ability to care for themselves.
  • Perform a standardized cognitive exam to test the Insured person’s memory, word recall, attention and other basic measures of brain health

The Insured person should have the following documents and information readily available during the face-to-face interview:

  • Two forms of photo identification (license, ID card, passport);
  • Names and phone numbers of all primary care and treating physicians;
  • A list of all current medications, including dosages;
  • Names and contact numbers for any current caregiver(s); and
  • Medical history, such as hospital confinement dates, procedures and diagnoses.

Eligibility Review Process

A Benefit Analyst will be assigned to evaluate the Insured person’s claim.

The Benefit Analyst will work directly with the Insured person, or the Insured person’s personal representative, and care providers, to gather all required claim forms, which may include, among possible others:

  • Attending Physician Statement
  • Insured Statement
  • Authorization to Release Information

During the eligibility review process, the Benefit Analyst will evaluate the type(s) of Long Term Care Benefits the Insured person wishes to access and the policy or certificate’s coverage limits. The Benefit Analyst will also consider the Insured person’s medical records, assessment interviews, and provider information to complete a thorough review of the 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.

Benefit Payments

Once the claim has been approved and the elimination period met, payments will be distributed from the policy.  The frequency is based on the insurance company (usually every 2 – 4 weeks). The payments can be made directly to the insured or an ASSIGNMENT OF BENEFITS can be established, and the benefits can directly pay the provider.