Long-term Care Claims

Call the OneAmerica Financial Long-Term Care Claims Department toll free at 800-352-6608. Care Specialists are available Monday through Friday, 8 AM – 5 PM EST to discuss the claim process and the benefits available.

Based on your preference, the Care Specialist sends you the claim forms by e-mail, fax, or mail. You can also click the “Claim Process” button above to obtain claim forms online.

OneAmerica Financial can release policy information only to the:

• policyowner;
• policyowner’s validated legal representative; or
• policyowner’s active broker/agent of record (excluding medical information).

An insured/annuitant who is not the policyowner is only entitled to receive policy information relevant to his/her claim.

When contemplating the need for long-term care services, you should contact OneAmerica Financial before any substantial expenses have been incurred to ensure that the condition, service(s), and care provider(s) qualify for benefits under the long-term care policy.

The policyowner and insured/annuitant or their designated legal representative(s) must complete and sign the Long-Term Care Claim Form and Authorization. Suppose the policyowner or insured/annuitant cannot sign these forms and is helped by someone who isn't their designated legal representative. In that case, the person helping the policyowner or insured/annuitant may contact us toll-free for guidance on how to proceed.

Mail, e-mail, or fax claim forms and any other requested documentation to:

OneAmerica Financial Partners, Inc.
Long-Term Care Claims
P.O. Box 6008
Indianapolis, IN 46206-6008
E-mail: longtermcareclaims.ind@oneamerica.com
Fax number: (317) 285-5239

Care Specialists trained to adjudicate long-term care claims work directly with the insured/annuitant or his/her legal representative during the claim determination process.

Claims received are acknowledged within five (5) business days. Each claim is unique regardless of claim complexity. The Care Specialists communicate regularly with the insured/annuitant or his/her legal representative throughout the process. The time required to make a benefit determination may vary.

OneAmerica® may require additional information during the claim process. Additional documentation requested may include, but is not limited to:

• Physician and/or hospital records;
• Cognitive testing and results;
• Care provider notes;
• Plan of care, prepared and signed by licensed health care practitioner;
• Assessment performed by care provider;
• Independent assessment; and
• Care provider licensure.

Each long-term care insurance policy specifies the conditions under which benefits are payable. The assigned Care Specialist can explain to the insured/annuitant or his/her legal representative the policy requirements and conditions under which benefits are payable.

Your policy contains a wide variety of eligible benefits that may or may not include benefits for long-term care facilities, assisted living facilities, and home health care agencies. Refer to your policy for a detailed outline of benefits.

For example, many of our policies require an insured/annuitant to qualify as a “chronically ill individual.” Meaning the individual is unable to perform two (2) activities of daily living without substantial assistance or is severely cognitively impaired as certified by his/her licensed health care practitioner.

A home health care services provider must:

• Regularly engage in providing services under the regular supervision of a registered nurse;
• Provide services under a plan of care prepared and signed by a licensed health care practitioner that is consistent with an assessment; and
• Maintain daily records/care notes.

The elimination period/waiting period is the number of days (specified in the policy) during which the insured/annuitant’s claim must meet all qualifying policy requirements before any subsequent eligible services are reimbursed under the terms and conditions of the policy. No long-term care insurance benefits are paid during the elimination period.

Any days in which the insured/annuitant’s condition does not qualify for benefits, or days in which the insured/annuitant is receiving care from an ineligible care provider, do not count toward satisfying the elimination/waiting period.

The insured/annuitant should file the long-term care claim as soon as he/she begins receiving long-term care related services. The insured/annuitant is not required to satisfy the elimination/waiting period before filing. However, the insured/annuitant must meet the elimination/waiting period before subsequent eligible charges will be reimbursable under the policy's terms and provisions.

Recertification generally occurs on an annual basis but may occur more frequently – mainly if there is a change in provider, level of care, type of care, frequency of care, or the expected recovery period for the qualifying medical condition is less than a year.

Choosing a long-term care service provider is an important, personal decision. Please keep in mind the policy contains requirements that a long-term care service provider must meet for an otherwise eligible claim to be reimbursable. For this reason, we recommend the insured/annuitant, or his/her legal representative call the OneAmerica Financial Long-Term Care Claims Department at 800-352-6608 early in the process of changing providers and provide the following to determine if the new care provider qualifies:

• Name of the new long-term care service provider;
• Address and phone number of the new long-term care service provider; and
• Date the new long-term care service provider will begin providing services to the insured/annuitant.

The Care Specialist will contact the new care provider, the insured/annuitant, or the legal representative if additional information is needed.

The insured/annuitant or his/her legal representative has the right to appeal an adverse benefit eligibility claim decision. If benefit eligibility is denied, the insured/annuitant or his/her legal representative receives a denial letter which provides:

• A summary of the benefit eligibility requirements;
• The reason the claim did not meet the benefit eligibility requirements;
• Sources of information used to make the determination; and
• Information and instructions for the claims appeal process.