Long-Term Care Rider claim
Long-Term Care Rider claim
Here’s everything you need to know about accessing your long-term care benefits:
1 Call us
Give us a call at 888-887-2739.
John Hancock will mail you a claim initiation kit and a HIPAA form.
Please ensure that the benefit eligibility requirements, as defined in your LTC rider, are met.
Most policies define the benefit eligibility criteria in terms of your inability to perform certain activities of daily living* or your level of cognitive function. The rider contract criteria varies by product, so you will want to review this section of your rider closely.
2 Submission
Submit all requirements to the Claims Department.
Fax:
617-572-7979
Mail:
John Hancock LTC Claims
PO Box 55231
Boston, MA 02205
3 Determine benefit eligibility
John Hancock will review your completed claim initiation kit. Based on your individual situation, the review may also involve an on-site assessment in your home or require us to obtain records from your care provider(s).
The documentation will be reviewed to determine if you are eligible for benefits. This review usually takes about 40 business days from initiation to decision.
While you are awaiting benefit eligibility approval, continue to collect all invoices. As soon as you receive approval, gather all your long-term care service invoices received to date and submit them to John Hancock for processing. This will ensure that you receive appropriate credit toward the elimination period as quickly as possible (see step 5 for additional details). Continue to submit invoices regularly for credit/reimbursement.
4 Ensure care provider information is up to date
The best way to ensure your provider information is up to date is to register for an online LTC account.
The care provider eligibility process can begin as soon as you start a claim. Once your online account is set up, you can update information related to providers you listed during your claim initiation process. You can also add new care providers. It's important to do this as soon as a new provider is used. Just sign in to your account and send the following information via the message center:
- Care provider name
- Care provider address
- Care provider phone number
- Type of care
Or you can call us at 800-233-1449.
If using an independent care provider (ICP), please complete the ICP form. To request the ICP form, sign in to your account and submit a request through the message center or call 800-233-1449.
In addition to verifying benefit eligibility, John Hancock will verify that each long-term care service provider meets the criteria for a qualified provider.
Please check with your provider(s) for any special release forms that may be required in order for John Hancock to obtain the necessary information regarding your claim.
5 Satisfy elimination period
There is typically a set period of time, defined in your contract, when John Hancock will not pay for expenses incurred. You will be eligible for reimbursement when you receive care for a certain number of days and/or dollars after you meet the benefit eligibility criteria.
Please note — invoices supporting these costs may be required to be submitted for these days to be credited. Services covered by Medicare may count toward your elimination period. It is recommended that you submit within 30 days of receving these services.
The requirements of the elimination period (e.g., length, dollars spent, etc.) vary widely based on the type of product you have and the options you selected at time of purchase. There may even be some types of services that can be reimbursed during this elimination period. We recommend that you review this section of your contract closely to understand the specifics of your coverage.
Medicare charges: If your LTC rider requires that your expenses are incurred to meet the elimination period, you may be able to receive credit for covered services that are paid by Medicare. You will need to provide copies of the MEDICARE UB04 forms and submit those for processing. The UB04 form is a document care providers use to submit charges to Medicare. You may not always receive this documentation, so let care providers know right away that you will need copies of the UB04 statements. A Medicare Explanation of Benefits does not contain the detail needed to apply credit to the elimination period.
6 Benefit reimbursement
Submitting itemized invoices online is a convenient way to ensure that you receive credit towards the elimination period and benefit reimbursement for eligible long-term care expenses, once the elimination period is met.
Invoices must be submitted every 30 days to avoid claim closure due to inactivity.
You can also submit invoices via mail or fax:
Mail:
John Hancock LTC Claims
P.O. Box 55231
Boston, MA 02205
Fax:
617-572-7979
Things to note about accessing your benefits:
Most coverage offered by John Hancock follows a reimbursement model — meaning, you incur certain long-term care expenses and then you are reimbursed for the actual charges that are incurred up to maximums defined in your rider. To apply for reimbursement, submit an invoice from your care provider that outlines each date of service, the type of service provided and the charge for the service.
Facility bills: Many facilities bill in advance. While facility bills may be submitted in advance, payments will not be released until the end of the month.
Home health care agency bills: Daily care charges including type of care provided, duration and charge details must be itemized on invoices submitted for reimbursement. If you employ an ICP rather than an agency, you will need to use an ICP service bill provided by John Hancock after provider approval.
* Activities of Daily Living —Personal care activities that may include bathing, dressing, eating, transferring, toileting, continence, and mobility.
** The insured is financially responsible to their care providers, including charges not covered by the LTC rider.
Insurance products are issued by: John Hancock Life Insurance Company (U.S.A.), Boston, MA 02116 (not licensed in New York) and John Hancock Life Insurance Company of New York, Valhalla, NY 10595.
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