Payment options are direct billing on an annual, semi-annual or quarterly schedule. Also available are electronic monthly payments, debited through a checking account.
Forms, flyers and answers to your questions
The following are the forms, answers to frequently asked questions and informational resources to help you manage your long-term care coverage.
Claims Forms
Reimbursement
Independent Care Provider Service Bill
If the insured is using an Independent Care Provider, rather than a caregiver employed by an agency, please have the insured and the provider list the itemized charges using the Independent Care Provider Service Bill; use of any other billing format is not eligible for reimbursement for this provider type. Once the form is completed, we ask that the insured submit it to John Hancock.
Direct Deposit Form
If the insured would like to receive reimbursement payments on an active claim via a direct deposit into his/her checking account, complete this form and return it with a copy of a voided check.
Assign Benefits Directly to Provider
If the insured would like to have benefits reimbursement on an active claim made directly to a provider he/she must provide the following:
1.Assignment of Benefits Form (completed by the insured)
The Assignment of Benefits form (AOB) will authorize us to make reimbursement payments for covered services directly to the designated provider. The AOB form (completed by the insured) must be returned with a W-9 Form (completed by the provider).
2.W-9 Form (completed by the provider)
Please note: this W-9 is different from any personal W-9 you may have provided previously to John Hancock. This form needs to contain information about your provider and must be signed by your provider.
Miscellaneous
Fax Cover Sheet
Please use the Fax Coversheet when submitting claim initiation information, request for reimbursement, or other forms in connection with the John Hancock long-term care insurance claim. Including the insured’s name and policy/claim number on the sheet will help us expedite your request.
HIPAA Authorization Form
If the insured would like someone to be able to speak with John Hancock about the long-term care insurance claim, please be sure to complete question 5 of the HIPAA form with the full names.
Note: This only authorizes us to communicate with these parties about your claim. It does not authorize them to sign forms / receive benefit reimbursement on behalf of the insured.
Benefit Eligibility Appeal Form
In the event that the insured wishes to appeal John Hancock’s benefit eligibility decision, after a review of the details provided in the decision, he or she can use this form to provide us with additional information in support of the initial claims request.
Form Signatures
The insured is required to complete and sign all claim forms. However, if the insured wishes to designate someone to make decisions on his/her behalf, the designee must have financial Power of Attorney or Guardianship. That person will then have the right to complete forms related to the claim. We will be unable to process a form signed by someone other than the insured unless we have received Power of Attorney or Guardianship documentation.
Frequently Asked Questions:
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Contact Us
For any questions related to your long-term care coverage, our customer service representatives are happy to help. (Monday through Friday, 8:00 a.m. to 6:00 p.m. EST.)
Glossary of Terms
Having difficulty interpreting your policy or certificate? Click here for a glossary of terms used commonly used.
Cost of Care
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John Hancock Life and Long-term care insurance products are issued by: John Hancock Life Insurance Company (U.S.A.), Boston, MA 02210 (not licensed in New York); and in New York by John Hancock Life Insurance Company of New York, Valhalla, NY 10595 (Life insurance) and John Hancock Life & Health Insurance Company, Boston, MA 02117 (Long-term care insurance).
The John Hancock Vitality Program is available with select John Hancock policies. Please consult your financial representative as to product availability, additional information, costs, and complete details on coverage. Product availability, features, benefits and costs may vary by state. The life insurance policy describes coverage under the policy, exclusions and limitations, what you must do to keep your policy inforce, and what would cause your policy to be discontinued.
Vitality is the provider of the John Hancock Vitality Program in connection with life insurance policies issued by John Hancock.
Premium savings are in comparison to the same John Hancock policy without the Vitality program. Premium savings over the life of the policy will vary based upon policy type, the terms of the policy, and the level of participation in the John Hancock Vitality program.
Vitality Rewards may vary based on the type of insurance policy purchased for the insured (Vitality Program Member) and the state where the insurance policy was issued. John Hancock Vitality Program rewards and discounts are only available to the person insured under the eligible life insurance policy. Rewards and discounts are subject to change and are not guaranteed to remain the same for the life of the policy.
REI is not affiliated with the John Hancock Vitality Program. REI does not sponsor, endorse or have any responsibility for this promotion.
Amazon Prime Membership available to Vitality PLUS members who have reached Platinum Status for three consecutive program years.
For Amazon.com Gift Cards, restrictions apply, see Amazon.com/GC-legal.
The HealthyMind (Headspace) and Hotels.com benefits are not available in New York.
In New York, entertainment, shopping, and travel rewards are not available and are replaced by healthy living and active lifestyle rewards.
Accessing a policy’s potential cash value via loans and withdrawals will reduce the death benefit and the cash surrender value, and may cause the policy to lapse. Lapse or surrender of a policy with a loan may cause the recognition of taxable income. Withdrawals in excess of the cost basis (premiums paid) will be subject to tax and certain withdrawals within the first 15 years may be subject to recapture tax. Additionally, policies classified as modified endowment contracts may be subject to tax when a loan or withdrawal is made. A federal tax penalty of 10% may also apply if the loan or withdrawal is taken prior to age 59 1/2.
Apple Watch program is not available in New York. You can order Apple Watch Series 3 (GPS) or Series 4 (GPS) by electronically signing, at checkout, a Retail Installment Agreement with the Vitality Group, for the retail price of the watch. After an initial payment of $25 plus tax, over the next two years, monthly out of pocket payments are based on the number of workouts completed. Upgrade fees apply if you choose (GPS + Cellular) versions of Apple Watch Series 3 or Series 4, larger watch case sizes, certain bands and case materials. Apple is not a participant in or sponsor of this promotion. Apple Watch is a registered trademark of Apple Inc. All rights reserved.
HealthyFood savings are based on qualifying purchases and may vary based on the terms of the John Hancock Vitality program.
© 2018 John Hancock Life Insurance Company (USA).
