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.
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 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.
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.
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.
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.
Each policy outlines the specific types of eligible providers and the covered services
that are eligible for reimbursement. We recommend that you review your policy before
hiring a care provider.
John Hancock must verify that each service provider meets the requirements as defined
in your policy before a bill is submitted. You must notify John Hancock if the insured
changes providers or adds additional providers.
Simply notify the Long-Term Care Service Center at 800-233-1449 before you add a
new provider. The process for review includes the following steps:
No. Provider eligibility varies by policy. John Hancock reviews each provider to
If you would like assistance locating a provider, John Hancock offers a referral
service. Please contact us to request assistance. Referral does not guarantee that
a particular provider will meet the eligibility criteria outlined in your policy.
You must still contact John Hancock as described above to verify provider approval.
You have the right to appeal an adverse claim decision regarding provider eligibility.
If a provider is denied, you will receive a denial letter that provides a summary
of the eligibility requirements.If after a review of this information you feel that
your provider does meet 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.
Most John Hancock long-term care insurance policies have an Elimination Period (also
called a Waiting or Qualification Period) that must be satisfied before benefits
can be paid. You can think of it like the deductible on your auto insurance.
For most policies, the Elimination Period is not met until you have received covered
services from an approved provider for the number of days specified in your policy
while you remain benefit eligible. The services are paid by you, or a third party,
e.g. Medicare, during the duration of the Elimination Period. The specific requirements
of the Elimination Period vary by policy, so you will need to refer to your policy
to determine the exact terms that apply.
You must remain benefit eligible to accrue days to meet the Elimination Period requirement.
If the Elimination Period is a service day Elimination Period (vs. calendar day),
you will also need to submit bills from an approved provider for covered services.
Your Explanation of Benefits will let you know when the Elimination Period has been
If your Medicare has paid for any long-term care services covered by your policy,
you should submit
UB04 bills from Medicare. These charges may help credit your Elimination
Period. However, we are unable to accept a Medicare Explanation of Benefits. You
should contact your long-term care service provider to obtain a copy of any applicable
You are eligible for long-term care insurance benefit reimbursement after three
steps have been completed:
Payment/credit to the Elimination Period will not be made for any service incurred
prior to the established effective date of benefit eligibility communicated at time
of benefit eligibility determination.
Bills will not be considered for payment until after the insured has been notified
of the outcome of the Benefit Eligibility Review. Once you have been notified that
you meet the benefit eligibility requirements and your care provider has been approved,
we recommend you submit bills on a monthly basis.
Reimbursement occurs only after services have been rendered. The one exception to
this is Home Modification. If your policy covers Home Modifications under an “Alternate
Care Benefit”, you must submit a request with three estimates in advance of any
modification work. John Hancock must review and approve this request before
the work begins.
If you still need to credit your Elimination Period and Medicare has paid for any
long-term care services covered by your policy, you should submit UB04 bills from Medicare. These charges may help credit
your Elimination Period. However, we are unable to accept a Medicare Explanation
of Benefits. You should contact your long-term care service provider to obtain a
copy of any applicable UB04 forms.
You must submit itemized bills for reimbursement.
All bills must include:
We are unable to accept a bill with handwritten corrections/changes. Please ask
your provider for a clean copy of the updated statement.
Itemized bills may be submitted by a provider on your behalf if you have an arrangement
with them to do so. Please note that service providers do not automatically submit
bills for private long-term care insurance reimbursement. You will need to contact
your service provider to enquire about an arrangement to submit bills on your behalf.
Here are some examples of billing statements that include all the required information
Independent Care Provider charges: If your policy covers services
provided by an Independent Care Provider, you must use the Independent Care Provider
Service Bill provided by John Hancock to submit a request for reimbursement.
Home Modification charges: If your policy covers Home Modifications,
under an 'Alternate Care Benefit' you must submit a request with three estimates
in advance. John Hancock must review and approve this request before the work begins.
You have two choices:
For facilities that bill in advance, payments are not released until the month is
Please note: reimbursements are made based on the daily benefit and lifetime benefit
maximums specified in your policy.
For each bill that is submitted, John Hancock will issue an Explanation of Benefits
(EOB) outlining charges reimbursed/credited to the Elimination Period along with
detail about any charge that is denied. If any reimbursement is due, the EOB will
be mailed with a check to the insured.
Yes, you can receive care in both locations. You will need to notify us when you
change your location to ensure we send payments and correspondence to the appropriate
address. If a residence is not in the United States, please refer to your policy
to see if you have an international coverage provision.
Approved claims will be reviewed periodically to determine ongoing benefit eligibility.
The process is similar to the initial benefit eligibility review described above.
If it is determined that you no longer meet the eligibility criteria, we will send
you a letter outlining the effective date of the change in eligibility, the reason
for the denial, and the sources that were used to make the determination. Benefit
reimbursement will not be made for services incurred after the effective date of
the denial. You have the right to appeal the decision as described above in “Determine
Initial Benefit Eligibility”.
If you no longer meet any applicable waiver of premium provision in your policy,
you will be required to resume premium payment. The primary reason you would no
longer meet a Waiver provision is that your claim has ended, either because you
have recovered and no longer meet the benefit eligibility criteria or you no longer
receive any covered services.
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