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If you have questions or need assistance, contact
us. To learn more about what to expect when filing a long term
care insurance claim make a selection:
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Q: When am I eligible for long term care benefits?
A: You are eligible for benefits when you become chronically ill or disabled. A
person is considered chronically ill or disabled if he or she is unable to
perform at least two activities of daily living (ADL's) without substantial (as
defined and required by federal government on tax-qualified plans) assistance
from another person. These activities include bathing, dressing, toileting,
transferring, continence and eating. The ADL loss must be expected to last for
at least 90 days, as certified by a licensed health care practitioner. The ADL
loss must be re-certified every 12 months. You may also be considered
chronically ill or disabled if you suffer a severe (as defined and required by
federal government on tax-qualified plans) cognitive impairment that requires
substantial supervision by another person to protect you from threats to your
health and safety. Services must be provided according to a written plan of
care developed by your licensed health care practitioner.
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Q: What is an elimination period?
A: The elimination period is a specific number of days during which no long
term care benefits are payable by Unum.
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Q: Must I satisfy an elimination period before I file a long term
care claim?
A: No, you are not required to satisfy an elimination period prior to filing a
long term care claim. Long term care claims should be filed as soon as you
begin receiving long term care.
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Q: Where can I get a claim form?
A: You can access a long term care claim form on our website. Simply click here and select the long term care option under the group or individual heading,
depending upon your type of coverage. You can also call our Benefits Center at
1-800-693-4988 and we will fax or mail a claim form to you within two business
days.
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Q: Who completes the claim form?
A: Due to Unum's privacy policies and HIPAA (Health Insurance
Portability and Accountability Act) federal privacy rules, you or your
designated representative are required to complete the claim form and sign an
authorization for release of information. The information about your claim is
considered confidential. Please attach additional pages if more space is needed
to fully describe your condition and care needs. The claim form must be signed
by you or by your legally designated representative (someone who legally serves
as your power of attorney or guardian). A copy of the appropriate legal papers
that verify his or her ability to legally represent you must also be provided.
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Q: Where do I send the completed claim form?
A: After reviewing the claim form completely, sign and mail the form to:
Unum / Long Term Care Benefits Center
2211 Congress St.
Portland, ME 04122-2300
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Q: Who will review the claim?
A: After we receive your completed claim form, our Benefits Center will assign
a long term care benefit specialist to review all information relevant to your
claim. The benefit specialist is a trained professional with in-depth knowledge
of long term care issues. If, after reviewing the claim form, the benefit
specialist determines that additional information or clarification is needed,
he or she will call you. The final claims decision may also include input from
our in-house medical staff. Our medical staff consists of on-site physicians
and nurses who interpret and clarify medical conditions, reports and tests.
This input enables the benefit specialist to make informed decisions about
medically complex claims.
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Q: What information may be requested during the claim process?
A: Once we receive a signed claim form we will request supporting documentation
to make an accurate determination of your eligibility for benefits. The
following information or activities may be requested:
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Physician and hospital records
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Home health care agency or facility notes
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Caregiver records or interview by telephone
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A face-to-face functional assessment meeting with an independent medical
professional to determine your ability to perform activities of daily living or
to clarify the extent or existence of cognitive impairment
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Written plan of care by your licensed health care practitioner (as required by
federal government for tax qualified plans)
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Certification by a licensed health care practitioner that the disability is
expected to last a minimum of 90 days (as required by federal government on
tax-qualified plans)
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Q: Once I file a claim, how quickly can I expect a written reply?
A: Once we receive a claim, we will send you a written acknowledgement within 3
business days. The benefits specialist will send a letter reviewing the status
of the claim to you every 21 days. The process of evaluating a claim, including
requesting and reviewing any additional information that may be needed, takes
approximately 4 to 6 weeks from the time we receive a completed claim form to
the final claim determination. Each claim is unique and the time frame for a
determination may vary. Once a claim decision is made, the benefit specialist
will call you within 1 business day and will follow up with a clearly written
explanation of the basis for the decision.
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Q: Does Unum offer resources that can help my family
deal with long term care issues?
A: Yes. We offer LTC Connect, a voluntary and confidential counseling and
referral service you and your family can use to address long term care concerns
at no additional cost. We contract with LifePlans Inc. to provide this program.
It is different from many other long term care assistance programs because it
does not require you to use a particular provider or service. In addition, this
service is available to you as soon as your policy is effective; you don't have
to wait until you are out on claim to utilize the services. You can get
nationwide discount rates through LTC Connect on participating skilled nursing
facilities, assisted living facilities, home care providers, adult day care
facilities and hospice providers. You may also access discounts on durable
medical equipment such as wheelchairs, grab bars or ramps.
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Q: How can I access the counseling services of LTC Connect?
A: Individuals can get answers to questions about long term care by calling
1-888-868-6745. LifePlans Inc's care coordinators are available Monday - Friday
from 8 a.m. to 8 p.m. EST. During off-hours and holidays, you can leave a
voicemail message that will be returned within 1 business day. Care
coordinators will listen, provide objective information and help you explore
your options about a variety of topics including aging, home care, Medicare and
Medicaid provisions, safety checks or the demands of care giving.
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Q: If I have a question or concern about the status of a claim
or the claim process, where can I go for assistance?
A: If you have questions regarding a claim, you can call our Benefits Center
during regular business hours at 1-800-693-4988. We are committed to responding
to your questions within the following timeframes:
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If we receive an inquiry before 3 p.m. (EST), we will respond the same day.
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If you contact us after 3 p.m. (EST), we will respond the next business morning
before 10 a.m. in your time zone.
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Q: If I disagree with the claim decision, how can I appeal the
decision?
A: If you are not satisfied with the claim decision, you can ask to have the
claim reviewed by an independent appeals area within our company. The request
must be in writing and should include all supporting materials or information
that will help us review the claim. We will review the appeal and all new
information, and will notify you of our decision within 60 days of receiving
the appeal. If special circumstances require additional time for processing,
you will be notified of the reasons for the delay. In this case, a decision
will be made within 120 days following our receipt of the request for review.
The final decision on the appeal, including the reasons for the decision, will
be communicated to you in writing.
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