Long term care insurance

LTC-116 (9-10)

Facts about your long term

care beneﬁts

Unum Life Insurance Company

of America, Portland, Maine

First Unum Life Insurance Company,

New York, New York

Provident Life and Accident Insurance

Company, Chattanooga, Tennessee

Long term care insurance is underwritten by the following

subsidiaries of Unum Group: Unum Life Insurance Company

of America, First Unum Life Insurance Company,

Provident Life and Accident Insurance Company.

Contents:

pg 4 Eligibility

5 Satisfying the

Elimination Period

6 Obtaining a claim form,

ﬁling a claim

8 Determining Eligibility

10 Additional requirements

10 A functional assessment

Our commitment

to helping you

Contents:

pg 4 Eligibility

5 Satisfying the

Elimination Period

6 Obtaining a claim form,

ﬁling a claim

8 Determining Eligibility

10 Additional requirements

10 A functional assessment

We know the important role long

term care (LTC) insurance beneﬁts

play in helping an individual who

is unable to live independently.

That’s why our knowledgeable

and experienced beneﬁt

professionals are committed

to providing our long term

care claimants with thorough,

fair, objective and timely

claim decisions. This brochure

describes in detail our customer

centered approach to the claims

process, and provides answers to

commonly asked questions

about ﬁling a long term care

insurance claim.

Eligibility

When am I eligible for long term

care beneﬁts?

You are eligible for long term care beneﬁts

when you become chronically ill or disabled.

Being chronically ill or disabled means that

you are unable to perform at least two

Activities of Daily Living (ADLs) such as

eating, bathing, continence, dressing,

toileting, and transferring without

substantial* assistance from another person.

It may also mean that you suffer from a

severe* cognitive impairment that requires

substantial supervision by another person

to protect you from threats to your health

and safety. The ADL loss must be expected

to last for at least 90 days, as certiﬁed by

a Licensed Health Care Practitioner.* The

ADL loss must be recertiﬁed every 12

months. Additionally, services must be

provided according to a written plan of

care developed by your Licensed Health

Care Practitioner.

*Italicized language is required by federal

law for plans which are intended to be

tax-qualiﬁed.

Satisfying the Elimination Period

What is an Elimination Period?

An Elimination Period is a speciﬁed number

of days that you must receive long term

care services before you begin receiving

beneﬁts from your policy.

Must I satisfy an Elimination Period

before I ﬁle an LTC claim?

You are not required to satisfy an

Elimination Period before ﬁling a claim.

Once your ability to perform two or

more ADLs is lost or you suffer a severe*

cognitive impairment, and you are receiving

care covered under your policy, you or your

representative should ﬁle a claim. Once

we receive your claim form, we can begin

gathering the medical information needed

to make a beneﬁt determination.

Obtaining a claim form,

ﬁling a claim

How do I obtain a claim form?

You or your designated representative

should call our LTC Beneﬁt Center at

1-800-693-4988 and we will fax or mail a

claim form to you within two business days.

You can also access a claim form via our

web site at unum.com.

What is the process for ﬁling a claim?

You or your designated representative

should fully complete the claim form,

attaching additional pages if more space

is needed to fully describe your condition

and care needs. The claim form must be

signed by you, or by a legally designated

representative (such as someone to whom

you have granted Power of Attorney) who

must provide a copy of the appropriate

legal papers. Your physician’s signature

is not required. This authorization is used

to request medical information and other

pertinent documentation.

Once we receive your claim, we will

send you or your representative a written

acknowledgment within three business

days. At that time, a Beneﬁts Specialist

will be assigned to your claim. If, after

reviewing your claim form, the Beneﬁts

Specialist determines that additional

information or clariﬁcation is needed, he or

she may call you or your representative.

What is the role of the

Beneﬁts Specialist?

The Beneﬁts Specialist assigned to your

claim is a trained professional, and will be

responsible for coordinating all aspects of

your claim. Beneﬁts Specialists have in-

depth knowledge of long term care issues

and have access to the resources needed

to manage your claim in the most effective

way possible.

Your Beneﬁts Specialist may request copies

of medical records or other documentation

that we need to make a decision about

your beneﬁt. Throughout the claims process,

your Beneﬁts Specialist will stay in contact

with you and your family to provide support

and monitor your progress. The Beneﬁts

Specialist also stays in touch through status

letters sent to you or your designated

representative every 21 days until a

decision is reached.

In addition to our Beneﬁts Specialists, the

LTC Beneﬁt Center has a dedicated Service

Unit. This group provides telephone support

to our customers during the claims process.

These representatives have extensive LTC

knowledge and claims experience, and are

ready to answer your questions when you

call. You can feel conﬁdent that you will

receive the highest quality service.

What is the next step in the beneﬁt

management process?

Once your claim and all additional

information is received, a ﬁnal claim

determination is made regarding your

beneﬁts. The average time frame from

receipt of a completed and properly signed

claim form to ﬁnal claim determination

is approximately four to six weeks. Of

course, each claim is unique and you may

experience time frames that are different

from this.

Once a claim decision is made, the

Beneﬁts Specialist will call you or your

representative within one business day,

and will follow up with a clearly written

explanation of the decision and the basis for

the determination.

Determining eligibility

How is my beneﬁt eligibility determined?

Once we receive a signed claim form, we

will request supporting documentation

to make an accurate determination of

your eligibility for beneﬁts. Supporting

information may include:

• physician and hospital records;

• home health care agency or facility notes;

• caregiver records or interview by

telephone; or

• a functional assessment.

A Beneﬁts Specialist thoroughly reviews all

the information relevant to your claim. Our

in-house medical staff may also have input

into the ﬁnal claims decision. If we have

difﬁculty obtaining medical records, we

may request assistance from you or your

representative to help speed up the process.

What role does the medical staff play in

my claims decision?

Our medical staff consists of on-site

physicians and nurses who interpret and

clarify medical conditions, reports and tests.

This input enables the Beneﬁts Specialist to

make informed decisions about medically

complex claims.

If I have questions, how can I reach a

Beneﬁts Specialist?

If you have questions regarding your claim,

you can call us at any time. It’s important to

you — and to us — that you receive a timely

response. Our commitment is to respond to

your calls within the following time frames:

• If we receive your inquiry before 3 p.m.,

Eastern Standard Time (EST), we will

respond to you the same day.

• If you contact us after 3 p.m. (EST),

we will contact you the next business

morning before 10 a.m. in your time zone.

Additional requirements

Some policies require that additional

documentation be submitted to us.

If you have a tax-qualiﬁed plan, the

federal government stipulates that your

Licensed Health Care Practitioner must

certify that your disability is expected

to last a minimum of 90 days. You will

also be required to submit a Plan of Care

developed by your Licensed Health Care

Practitioner. Please see your contract (under

“Claim Information” section) for speciﬁc

requirements.

A functional assessment

What is a functional assessment?

A functional assessment is a face-to-

face meeting with you and a medical

professional and is used to obtain additional

details about your ability to perform

Activities of Daily Living, or to clarify the

extent or existence of cognitive impairment.

Our company works with an independent

agency that contracts with assessment

professionals throughout the country, who

can assess your needs regardless of where

you live. Assessments are not necessary

on every claim. Your Beneﬁts Specialist

will notify you or your representative if an

assessment is needed in order to make a

ﬁnal eligibility determination on your claim.

Experience you can rely on

Unum has been in the employee

beneﬁts business for more than

160 years. We provide beneﬁts

to 12 million individuals in the

U.S.,

helping them protect their

families and preserve their assets.

We are committed to providing

you with a high level of service.

You can rely on us for a smooth,

efﬁcient claims process and for

personal support when you need

us most.

1 Unum internal data, 2008. This statistic does not include

Colonial or Unum UK.

registered trademark and marketing brand of

Unum Group and its insuring subsidiaries.

LTC-116 (9-10)

This is not intended to be a complete description

of the individual and group long term care policies

underwritten by Provident Life and Accident

Insurance Company, Unum Life Insurance Company

of America, and First Unum Life Insurance Company.

Some coverage options may not be available in all

states. These policies have exclusions and limitations

that may affect beneﬁts payable. For costs and

complete details of coverage, refer to Policy Series

LTC03, RLTC03, GLTC04, RGLTC04; in New York refer

to Policy Series LTC03, LTC03F, LTCP03, LTCP03F,

LTCT03, LTCT03F, RLTC03, RLTC03F, RLTCP03, RLTCP03F,

GLTC04, RGLTC04 or call your Unum or First Unum

representative. In Florida, Idaho, Oklahoma and

Virginia, refer to LTC03, LTCP03, LTCT03, RLTC03

or RLCTP03 (underwritten by Provident Life and

Accident Insurance Company). In Texas, refer to

LTC03, LTCP03, LTCT03, LTC03A5, LTCP03A5, LTCT03A5,

LTC03A10, LTCP03A10, LTCT03A10, RLTC03, RLTC03A5,

RLTCP03A10 (underwritten by Provident Life and

Accident Insurance Company), TQGLTC952, GLTC04,

or RGLTC04 (underwritten by Unum Life Insurance

Company of America).