We strive to provide our long-term care insurance policyholders with excellent service and helpful support and advice, especially during claim time. To initiate a claim, please call (877) 795-8493. Our Policyholder Center has dedicated specialists available to answer questions about your policy's coverage and explain the claims process.
For your convenience, we offer many commonly requested forms on-line. Simply print, complete and mail the appropriate form to us. To access these files, your system must be able to read files in pdf format.
Automatic Withdrawal Form
This form should be completed and sent to the address on the top of the form when the Policyholder would like to have premium payments automatically withdrawn from their bank account.
Change of Address Form
This form should be used to inform us of any Policyholder change of address. This allows us to update our records so we know how to reach you.
Duplicate Policy Request Form
This form should be completed and returned to the address on the top of the form when a duplicate policy is needed.
Third Party Designee Form
This form should be completed and sent to the address on the top of the form when the Policyholder would like a third party to be notified in the case of an unpaid premium.
Electronic Funds Transfer Agreement
This form should be completed and sent to the address on the top of the form when the Policyholder has an approved claim and would like to have benefit payments directly deposited to an account.
Medical HIPAA Release Form
This form is used to obtain Policyholder's medical information when filing a claim. Please use this form if one was not included in the claim packet or an updated form is required.