Instructions for CLAIM WORKSHEET

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This page will give you the majority of the benefits in your policy in one at-a-glance page. Most of the information you need for this can be found on your Schedule of Benefits page (also called the Declaration Page) that is usually found in the first 5 or 7 pages of the policy. However, this sheet asks for more details that are often not obvious from that Benefit page. These details are crucial in helping you plan wisely for using this resource.

An example may help. All policies have an “elimination period” (also called a wait window) embedded in the policy. Think of it like a deductible – it is the amount of care you have to pay for fully out of pocket before the policy will kick in to pay. This window of time may be either SERVICE day or CALENDAR day. Calendar day is just what you think…every day the calendar flips over is a day that meets your elimination period. A service day, however, means you must have an invoice for care on that day (to prove that you had care) for the day to count. So if a person is getting 2 days a week of home care and family are doing the rest of the care, then on calendar day elimination period, all the days are counting. But on a service day elimination period, only 2 days that week are counting! If you are note getting care every day, it will take much longer to meet a service day elimination than a calendar day version. So, this seeming ‘detail’ as it turns out is actually crucial in understanding how the claim/policy will operate.

After all our years of filing claims, believe us when we say we put only important things on this page. These are the things that you need to know to be wise about use of the resource.

If you can’t tell from the Schedule of Benefit page what the answer to each question might be, you can either:

read the relevant sections of the contract/policy to see how they define or delineate the operation for that item…OR
call the insurance company and ask these questions of the representative on the phone. Trust us on this: you want to know the answers to all the questions on this one page form!

If any of the vocabulary are unclear, have a look at our glossary (located under the Resource tab at top of our web page).

We want you to get all your benefits from this policy. You have paid for it, after all. Now it is time for the policy to step up and pay for your care.

As always, if we can be of service, please don’t hesitate to reach out to us.

Stana Martin, PhD, founded Mrs LTC to provide a top-quality resource for clients and customers who need help with long term care claims or insurance comparisons.