Definitions

Benefit eligibility
The conditions that must be met in order for you to be entitled to your FLTCIP coverage.

Benefit eligibility date
The date when you started needing long term care assistance.

Need more help? Get answers to frequently asked questions about claims.

 

Determining Benefit Eligibility

Determining Benefit Eligibility

This process can take several weeks, depending on the amount of information (and its availability) needed to determine your claims benefit eligibility date. This is the date when you started needing long term care assistance, according to the policy.

We'll send you a written notice of our decision on whether or not you are eligible for benefits no later than 10 business days after we receive all of the requested information.

Benefit eligibility approval

If your benefit eligibility is approved, a care coordinator will call you, and you'll receive a letter stating the date you are eligible for benefits. The letter will include necessary claims instructions and forms that you can use for the submission of invoices and/or proof of payment. These claims forms are also available to download online.

As part of this process, we'll assign a team of care coordinators to work with you and your family members to develop a plan of care that meets your individual needs. Our care coordinators can also help you find high-quality care providers in your area; share the results of state survey reports about service availability, quality, costs, and licensing; arrange for discounted services; monitor the care you are receiving; and assist with changing your plan of care as your needs change.

Benefit eligibility denial

If your benefit eligibility is denied, a care coordinator will call you, and you'll receive a letter stating the reason for the denial. If you still feel strongly that you're eligible for the benefits of your plan, you may request a review of the denial by sending a written request to us no later than 60 days after the date of the denial. After our review is completed, we'll send you a written notice of our decision. If we uphold the initial denial, at that time you may request an appeal.

For more information about the review and appeals process, refer to the most recent FLTCIP Benefit Booklet we sent to you or review the downloadable PDF version within your online account.


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Register for an Online Account

We recommend that you create an online account if you've not done so already. Your online account will provide you with access to an overview of your current coverage, the number of waiting period days you have remaining (if any), your approved plan of care, and detailed invoices and an explanation of benefits paid on your behalf.

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