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



Authorization for Disclosure of Information

If you would like to authorize us to speak to a designated person about your coverage, complete and return the Authorization for Disclosure of Information form.

 

Monitoring  Your Claim

Monitoring Your Claim

It's not uncommon for an enrollee to enter claim, recover, and enter claim again in later years. Because conditions can change with time, while you are receiving care our care coordinators will review your benefit eligibility and plan of care at least once every 12 months and sometimes more frequently depending on your specific condition.

We may request additional information by: contacting you, your physician, or other persons familiar with your condition; accessing your medical records; having you examined, at our expense, by a licensed health care practitioner; and/or conducting an on-site assessment.

Notify us of any changes

You must inform us of any anticipated or actual change in your condition, care, caregivers, or stay-at-home needs (such as home modifications and durable medical equipment), as soon as you know about or need to make a change. Any requested change to your plan of care must be reviewed and approved by our care coordination staff prior to making the change in order to avoid reimbursement denials or delays.

Closing a claim

If long term care eligibility criteria can no longer be documented, you are considered recovered and therefore no longer eligible for reimbursement of benefits for your current claim.

The following are a few reasons why a claimant may no longer be eligible for benefits:


Image of son and father looking at brochure.

Using Your FLTCIP Benefits Brochure

If you've met the conditions for benefit eligibility, this brochure is intended to assist you at the time of claim by providing an overview of the process. It also contains important forms and instructions to assist you in the reimbursement of approved care expenses. There are two versions of this brochure: one for enrollees in a FLTCIP 1.0 plan and one for enrollees in a FLTCIP 2.0 plan.

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