Library of Long Term Care Claim Forms

When initiating an LTCi claim the insurance companies require the insured to complete a variety of documents. The most common documents are an Initial Claim Packet, Assignment of Benefits Form, Health Information Authorization (HIPPA) Forms and Electronic Funds Transfer Forms. For your convenience we have the most commonly required forms and documents available for the major Long Term Care insurance providers.

Penn Treaty Assignment of Benefits
Penn Treaty Attending Physician’s Statement
Penn Treaty Facility Certification of Care for Initial Claim
Penn Treaty HIPPA
Penn Treaty Policyholder Authorization to Release Information

Prudential

Prudential claim form

SHIP

SHIP claim form

Thrivent

UNUM

UNUM claim form

Washington National

Washington Mutual claim form

Your Trusted Source for Long Term Care Insurance Assistance and Advise

The Home Care Spot offers assistance with long term care insurance for our clients. In addition to proving free LCTi policy evaluations and free processing of home care claims for individuals with long term care insurance benefits, we can also provide free quotes for long term care insurance throughout Chicago and the North Shore suburbs including both Cook County and Lake County. We provide our home care, senior care and dementia care services to residents of Arlington Heights, Buffalo Grove, Chicago, Deerfield, Des Plaines, Evanston, Glencoe, Glenview, Highland Park, Fort Sheridan, Highwood, Kenilworth, Lake Forest, Morton Grove, Niles, Northbrook, Park Ridge, Lincolnshire, Lincolnwood, Libertyville, Skokie, Wilmette and Winnetka.

“Please pass on our happiness with our caregiver, Eloina. She is thoughtful, warm and friendly, helpful, prompt and kind. She’s always willing to help and just a delight. We leave town for the winter and sure hope you can get her back here again when we return.”

Fran and Mel G

“You are a very good agency. Pleased with your continued interest in our loved ones. Our caregiver is most Creative. Takes my husband to different places. Weather permitting, parks, Botanical gardens, Garfield Park conservatory planetarium, etc. on some cold rainy days to the malls to just walk.

J. G. and Family

I am writing you today to tell you how pleased I am with the care my mother is getting from her caregivers Annette and Shirley…I have found them to be conscientious, helpful, and consistent in their work…They both have shown initiative, and have gone above and beyond in caring for my mother…I appreciate all the work everyone at Homewatch has had to go through to get this team in place.

Dave S.

Thank you for your kindness. People like you make the world a nicer place in which to live.

Lenore

Your generosity made a tremendous difference in the quality of our sister’s final months. Thank you from the bottom of our hearts!

Betty, Kathy and Dan

I wanted to say thank you for the wonderful care and support your team showed to my parents, especially Altan, Suzanne and Betty. The attention they paid towards them and our family was such a comfort. We knew that they were in safe and experience hands. While our time with your your group was shor,t I know my parents and our family benefited from all of you. – Best wishes

Barbara C.

Thanks to your entire staff for the care John received over the past 15 months. The caregivers were all attentive, caring, professional, knowledgeable and above all kind

Lynn H.

I wanted to thank you again for your help and kindness during my family’s time of need. My dad’s life is a little more comfortable being able to remain in his house. You really are a friend. I am very grateful.

Wayne N.

I am a veteran of World War II, being most fortunate to have Kent O’Grady fill my needs of a caregiver. He is reliable and responsible. Thank you for your cooperation in for the excellent assistance of Kent.

David K.

“Tamika has been a care-giver for my mother, Yolanda, since 2011…she truly knows the meaning of care-giving, and my mother, my brother, myself and my daughters all consider Tamika to be a gift in our lives. We deeply appreciate her care-giving for Yolanda.”

Christine I.

“I wanted to say thank you for the wonderful care and support your team showed to my parents…we knew they were in safe and experienced hands.”

Barbara C.

“Many thanks for the wonderful services you provided to my mother…I really commend Homewatch on the quality of service, the caring attitude of those I worked with.”

Lucile K.