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Policy Questions

Can I increase or decrease my benefits?

We discontinued sales in October 2008 and you are not able to increase your coverage. However, you can contact us to discuss how you may be able to decrease the benefits in your policy to reduce the amount of premium you pay. Your options may include increasing the elimination period, decreasing the daily benefit amount, or decreasing the maximum benefits available under your policy. For more information, please call Policyholder Services at 1-800-362-0700.

 

How do I cancel my policy?

Send a written request, signed by the policyholder or the policyholder's legal representative, to Premium Services, P.O. Box 7066, Allentown PA 18105-7066, or fax to 610-967-4616. If your legal representative is signing for you, please include a copy of the appropriate legal paperwork (if not previously submitted).

 

I cannot locate my policy. What should I do?

Please call Policyholder Services at 1-800-362-0700  to request a copy of your policy, or complete and mail a Request for Duplicate Policy form. A $25 fee is charged for duplicate policies.

 

I recently moved. How can I change the address on my policy?

To change your address, call Policyholder Services at 1-800-362-0700, or complete and submit an Address Change Form. You can also mail or fax a written request signed by you or your legal representative. If your legal representative is signing for you, please include a copy of the appropriate legal paperwork.

 

My policy has lapsed. Can it be reinstated, and if so, what is the process for doing so?

If your policy has lapsed and you would like to discuss options for reinstatement, call Policyholder Services at 1-800-362-0700.

 

What does my policy cover?

Your benefits are explained in your policy. If you have any questions, please call Policyholder Services at 1-800-362-0700.

Premium Questions

Can I pay my premium over the phone?

No, not at this time.

 

Can I pay my premium through online banking?

Yes, we offer an automatic bank draft option for premium payments. For more information, please visit the Premium Payments section of this website. Your financial institution may also offer a bill payer system.

 

Can I pay my premium with my credit card?

No, not at this time.

Claim Questions

When do I need to file a claim for benefits?

Once you know that you will need long-term care services, please call Policyholder Services at 1-800-362-0700 to discuss filing a claim. Our representatives will be happy to answer your questions and send you an information packet containing complete instructions and required forms for you to complete and mail or fax to us.

 

What types of services are covered under my long-term care policy?

The types of covered services are specific to each policy, and generally include assistance with bathing, dressing, transferring, and assistance to the bathroom.

In some policies, assistance with meal preparation, light housekeeping, laundry, grocery shopping and transportation to medical appointments may be covered.

 

What types of services are not covered?

Services that are not reimbursable include, but are not limited to, pet care; trips to the beauty parlor, church, and social activities outside the home; and heavy housekeeping.

Policy terms require that care be provided to the policyholder while confined in his or her home. Please refer to your policy for specific information regarding the types of covered services.

 

How is eligibility for benefits determined?

Determining eligibility is a two-step process:

1. Benefit eligibility: Your medical condition and care needs are evaluated to determine if they meet the eligibility requirements of your policy.

2. Provider eligibility: The care provider you choose is evaluated to determine if the agency or private caregiver meets the criteria listed in your policy.

 

What information is required for benefit eligibility?

To simplify the claim process for you, we obtain information from two sources:

1.  Your physician(s): Information is required from your physician(s) about your current medical condition and care needs, and the anticipated length of time that care will be needed. We request this information directly from your physician(s). You can help by asking your physician(s) to promptly complete and return the required information to us.

2. In-home assessment: A nurse from an independent company representing Penn Treaty may visit you to conduct an assessment in your home. The nurse will call to schedule the appointment directly with you or your legal representative.

Sometimes, we must request additional information to provide clarification before we can make an eligibility determination. If additional information is required, we will notify you or your legal representative by letter of the status of the claim and the additional information needed.

 

How is provider eligibility determined?

Eligibility requirements for care providers vary by policy.  Please refer to your policy for the specific requirements for qualification.

Once the required information is received, a claim examiner will review it to determine whether your provider is eligible, based on your policy's requirements.

 

Once a claim is filed, how soon will I be notified about a claim decision?

It takes an average of 35 to 45 days after a claim is initiated to gather the necessary information to make an eligibility determination. To expedite this process, it is important that all requested information be provided to us as soon as possible.

 

If my claim is approved, when can I expect to receive claim payments?

Penn Treaty processes 97% of all claim payments within 15 days of receipt of all completed information. If a bill cannot be processed for any reason, we will notify you by letter of the status of the claim and any additional information needed to complete processing.

 

What should be submitted on a regular basis in order to receive payment for covered services provided?

If care is being provided by an agency, the agency can submit the bills and care notes directly to Penn Treaty. If care is being provided by a private caregiver, the caregiver must complete the Home Health Care Documentation form each day that they provide services. This form also serves as a bill.

 

How frequently should bills be submitted?

Bills for home health care services can be submitte as frequently as every two weeks, but must be submitted at least once a month.

 

What kind of documentation should the caregiver keep?

The caregiver should document the types of services that he/she is providing to you during the hours worked.

 

Where should bills and care notes be sent?

Bills and care notes can be submitted by mail or fax:

Mailing address: ATTN: Claims Department  PO Box 7066 Allentown PA 18105-7066

Fax: 610-965-6962.

 

What if my claim for benefits is denied?

In the unlikely event that your claim is denied, you will receive written notification explaining the appeal process.