Long-Term Care Plan
 

Filing Your Claim

This section describes your Long-Term Care (LTC) Insurance Plan’s claim filing procedures. 

CLAIM FILING ASSISTANCE
Assistance is available if you have a question about the LTC Plan’s claim filing procedure, or need help filing your claim. You can contact a John Hancock Customer Service Representative for assistance with claim questions at 1-800-711-9407 (Monday through Friday from 8:30 a.m. to 6:30 p.m., Eastern Time). 

The LTC Plan’s claim filing procedures are also described in the plan’s Insurance Certificate, which you can obtain from  Human Resources. 

CLAIM FILING PROCEDURE
You should follow these steps when filing your LTC Plan claim: 

Step 1: You should provide the Insurance Company with a notice of your claim within 30 days* after the onset of a covered health condition, or the start of any service that is covered by the plan. 

*or within the time limit specified by state law, if greater 

You can provide notice of your claim by contacting the John Hancock Customer Service Center at 1-800-711-9407 (Monday through Friday from 8:30 a.m. to 6:30 p.m., Eastern Time). You can also provide written notice of your claim by sending it to John Hancock at the following address: 

The John Hancock Life Insurance Company (U.S.A.)

Group Long-Term Care
PO Box 111
Boston, MA 02117
Attn: Long-Term Care Claims

Claim Form
After it receives notice of your claim, John Hancock will send an LTC Plan claim form to you. This form will be sent to you within 15 days after the date that John Hancock receives notice of your claim. 

If you don’t receive your claim form within 15 days, you should send written proof of your claim to John Hancock without the claim form. This proof should include the “proof of claim” information described in Step #2 below. 

Failure to provide notice of your claim within the submission period described above will not invalidate or reduce your claim if: 

  • it was not reasonably possible for you to submit your claim within the 30-day period; and
  • you submit your claim as soon as reasonably possible.

Step 2: You should send your completed claim form to John Hancock at the address shown in Step #1 within 90 days* after the date that you incur a covered LTC Plan expense. 

*or within the time limit specified by state law, if greater 

Proof of Claim
Your claim form submission must include written proof of your claim that is satisfactory to the Insurance Company. This proof must include all of the following: 

  • information identifying the insured person who incurred a covered LTC Plan expense;
  • a Plan of Care (as described in How Your Long-Term Care Insurance (LTC) Plan Works); 
  • the date(s) that the insured person incurred the covered LTC Plan expense;
  • a description of the covered service provided; and
  • information that identifies the provider of the covered service.

Failure to provide proof of your claim within the submission period described above will not invalidate or reduce your claim if: 

  • it was not reasonably possible for you to submit your claim within the 90-day period; and
  • you submit proof of your claim as soon as reasonably possible.

VALIDATING YOUR CLAIM
The Insurance Company has the right to do any or all of the following to validate your claim for LTC Plan benefits: 

  • contact you, your authorized representative, your physician, or another person who is familiar with your condition
  • require that you (or a person that the Insurance Company names) provide access to medical records pertaining to your condition
  • require that you undergo an examination by a licensed health care practitioner, and that an on-site assessment be conducted
  • require that you submit an explanation of benefits from Medicare, or any other source from whom you may have received reimbursement for a covered LTC Plan service. 
You can contact John Hancock Customer Service Center at 1-800-711-9407 (Monday through Friday from 8:30 a.m. to 6:30 p.m., Eastern Time) if you have any questions about the procedures for validating your claim. 

BENEFIT PAYMENTS
Your LTC Plan benefit payments will commence within 60 days after the Insurance Company receives and approves your completed claim form, proof of claim, and any other required claim materials. 

You can request in writing that LTC Plan benefit payments be made directly to your long-term care provider. If you don’t make this request, these payments will be made directly to you or your legal representative. 

Overpayment
The Insurance Company has the right to recover any LTC Plan overpayments made due to any error it makes in processing your claim. 

COORDINATION OF BENEFITS (COB)
Coordination of Benefits occurs when both the LTC Plan and another plan pay benefits for the same covered service. For example, this would occur if the LTC Plan reimburses you for covered nursing care and another plan pays you for the same care. 

If coordination of benefits occurs, the sum of the amounts payable by the LTC Plan and all other plans cannot exceed the total amount that the LTC Plan would have paid in the absence of a COB provision. 

The above is only a brief summary of the LTC Plan’s Coordination of Benefits (COB) rules. 

You should consult the LTC Plan Insurance Certificate for more complete information about the plan’s COB rules (you can obtain this certificate by contacting Human Resources). You can also contact John Hancock’s Customer Service Center at 1-800-711-9407 (Monday through Friday from 8:30 a.m. to 6:30 p.m., Eastern Time) if you have a question about these rules and how they work. 

 

DENIED CLAIMS
You can appeal a denied claim. The claim appeal procedures are described in the Administrative Information section of this SPD and in the Insurance Certificate, which you can obtain from Human Resources.