Reimbursement

The reimbursement process for expenses paid by you for long term care services depends on where you receive care and who provides that care. If you have a service day waiting period, you must also submit invoices to satisfy your waiting period before you can be reimbursed for services.

Submitting invoices

To help you be reimbursed as quickly and accurately as possible, these are the requirements for submitting invoices for each type of provider.

Informal caregiver

You must submit an Informal Caregiver Invoice form and proof of payment:

  • this includes, canceled personal, business, substitute, or cashier's checks; eStatements; money orders; online bill pay; or payroll payments
  • payments must be paid after services are rendered
  • payments made by cash or checks made out to cash are not reimbursable

Formal caregiver

If the caregiver's services are arranged and supervised by a home care agency or you receive care at an adult day care center, you must submit an itemized invoice that includes:

  • the complete name, address, and phone number of the agency or adult day care center
  • the individual dates of service
  • the total hours per day
  • the total charged per day
  • a description of services provided
  • the total amount charged per invoice

Facility

If you receive care in an assisted living facility, a nursing home, or a hospice facility, you must submit an itemized invoice that includes:

  • the complete name, address, and phone number of the facility
  • the individual dates of service
  • a description of services provided
  • the total charged per type of service
  • the total amount charged per invoice

Payment of benefits

We pay benefits using the expense-incurred method. This method reimburses you for actual charges you incur for covered services received up to a specific dollar amount. We only pay for covered services based on invoices that are submitted directly to us. And, the providers and services must match your approved plan of care.

Each time a payment is made for services provided for your care, an explanation of benefits is mailed to you and is available within your online account for your review. You'll typically receive reimbursement within 10 days after all required documents have been received.

Setting up an electronic funds transfer

Payments are either issued by electronic funds transfer (EFT) to your bank account or by check mailed to you. To initiate claims payments via EFT, please complete the Claimant Authorization of Claims Payments via Electronic Funds Transfer form. This form should be returned with a voided check.

Advanced billing

Some providers bill for services before they have been incurred. This is commonly referred to as advanced billing and is only allowed for services rendered in a nursing home or an assisted living facility. If a facility does bill in advance, payments are not made until after the first of the following month.

Assignment of benefits

Payments are usually made to you, the claimant, for expenses incurred. However, you have the option to request direct payment to certain home care agencies or facilities. Under this option, invoices are submitted directly to us by the provider and payments are made directly to the provider. To select this option, you must complete the Assignment of Benefits form*.

If your provider would like to be reimbursed by EFT, please offer them the Provider Authorization of Claims Payments via Electronic Funds Transfer form. This form should be returned with the completed Assignment of Benefits and W-9 forms.


*The assignment of benefits option is only available for home care agencies and facilities within the United States. And, it is not available for informal caregivers.

Tax information

Since the FLTCIP is a qualified long term care insurance plan, benefits you receive are not considered taxable income. You will receive a 1099-LTC for all claims payments that are made to you. We will also issue a 1099-MISC for claims payments that are made directly to a provider. These forms are mailed by the end of January for payments made in the previous year. Please consult with your tax advisor or certified public accountant to determine your responsibilities for an informal caregiver.

Deducting expenses

IRS Publication 502, Medical and Dental Expenses, provides information about what expenses you can include as a deduction. You can't include medical expenses that were paid for by the Federal Long Term Care Insurance Program (FLTCIP), whether they were paid to you or the provider of the medical services.


Note: This is not intended to provide tax advice. Always consult your tax attorney or certified public accountant when dealing with tax deductibility considerations.