Claims Frequently Asked Questions
Determine Initial Benefit Eligibility
When should a claim for long-term care insurance benefits be initiated?
You should contact John Hancock as soon as you feel that you may be in need of long-term
care services. We can then immediately start the process to determine whether you
are benefit eligible and whether your provider meets the policy requirements.
How is a claim for long-term care insurance benefits initiated?
To initiate your claim, all you have to do is to call John Hancock at 1-800-233-1449.
The first step in the claims process is to determine whether you are benefit eligible
and the date on which benefit eligibility began.
After the initial call, we will send you a Claims Initiation Kit that includes three
forms which gather the information needed to start the determination process. We
will send you a written acknowledgement upon receipt of the completed Kit.
Based on the information you provide, John Hancock will either arrange for a nurse
to visit you and make an assessment, or we will obtain clinical documentation from
your doctor or provider. In the case that multiple sources are required, it may
take longer to complete the benefit eligibility determination.
Once a claim is filed, how quickly will there be a written reply?
Once a review of the clinical documentation is complete, John Hancock will advise
you whether you have been determined to be benefit eligible. This notification usually
happens within 30 days of claim acknowledgement.
Who will review the claim for benefit eligibility?
A John Hancock Care Manager will review all the documentation we receive to determine
if you meet the benefit eligibility requirements in your policy. John Hancock will
notify you in writing of the claim decision.
Do I continue to pay premium while on claim?
It is imperative that you continue to make premium payments until you are notified
that you have met the Waiver of Premium provision (if applicable). While most policies
include some type of provision, they vary by policy and sometimes by the type of
care received. Please review your policy for more detail.
If I disagree with the benefit eligibility decision, can I request an appeal?
You have the right to appeal an adverse claim decision regarding benefit eligibility.
If benefit eligibility is denied, you will receive a denial letter that provides
a summary of the benefit eligibility requirements, the reason that you did not meet
the requirements, and the sources that were used to make the determination. If after
a review of this information you feel that you meet the benefit eligibility criteria,
you will need to submit an appeal request in writing. This request must state why
you disagree with the determination and what factors John Hancock should take into
consideration when reviewing the decision. The appeal request should be sent to
the attention of the Appeals Manager at the John Hancock mailing address provided
in the denial letter.