Apply for Long Term Care

Apply for Long Term Care

We’re here for you when you need to put your long term care (LTC) benefits to work. Applying for benefits is the first step to using LTC to cover care costs related to assistance with activities of daily living or severe and chronic cognitive issues. Learn how to apply below.

Qualification & Benefits FAQ

How do I qualify?

You can qualify for benefits if you need substantial assistance from another person to perform at least three of six basic Activities of Daily Living (ADLs): bathing, dressing, toileting, eating, getting in and out of bed or a chair (also called transferring), or managing bowel and bladder continence (peeing and pooping). You can qualify for benefits if your limitations are expected to last at least 90 days, or you have a documented severe cognitive impairment, such as Alzheimer’s, and you need continuous supervision from another person for safety. If you’re not sure whether or not you or a loved one has LTC coverage with WEA Trust, contact us. 

What are my benefits?

In general, your LTC benefits help cover care costs related to performing Activities of Daily Living in the event that you are physically or mentally unable to safely and consistently perform them yourself. Your plan covers a Skilled Nursing Facility (Nursing Home); Assisted Living Facility; Adult Day Care; Hospice; Home Care; and Respite Care. Your Benefit Summary contains your specific benefit values. We mail you a benefit summary regularly - if you need a copy of your Benefit Summary please contact us.  For complete information on your Benefits or coverage, view the complete Group LTC Plan document (Opens in new window) or Individual LTC Plan document (Opens in new window).

How is LTC insurance different from health insurance?

LTC insurance and health insurance serve different purposes. LTC insurance helps cover the costs of non-medical, extended care needed for activities like bathing and dressing, often required due to chronic conditions or aging. Health insurance primarily handles medical expenses for illnesses, injuries and treatments aimed at recovery. LTC insurance supports caregivers and custodial care on an ongoing basis, while health insurance focuses on addressing immediate healthcare needs. Both types of coverage play crucial roles in ensuring comprehensive healthcare support, but Medicare and your health insurance plan don’t typically cover custodial care.

How do I apply?

Contact us for assistance, to have the Application forms mailed to you, or follow the steps below. We will start counting your elimination period from the date the doctor signs the Provider Certification and Plan of Care forms (the forms cannot be backdated).  Once we receive your completed Application, doctor forms and medical records, we will review your claim to determine eligibility.

Step 1

Application for Long Term Care Benefits (Opens in new window) If you need help completing this document, call us at 800.279.4000.

Step 2

Provider Certification (Opens in new window) and Plan of Care (Opens in new window) - must be completed by your physician. 

Step 3

Send Medical Records that align with your physician’s certification of your condition and his/her recommendations for your long term care service needs. We accept dictated notes from recent clinic visits, rehabilitative therapy (physical, occupational or speech) notes, hospital discharge summaries, and facility/provider plan of care records. The medical records department at your clinic can coordinate release of these documents to us.

Step 4

Authorize others to speak for you. You may need your spouse, son or daughter to speak for you about coverage and claims. We are happy to provide you and them with general information about your plan. However, we cannot discuss your medical history, claims, or benefit amounts with family unless we have an authorization form on file. Complete the Designation of an Insurance Representative form (Opens in new window), or if you have a Power of Attorney document ready, you can send us a copy.

What happens after I apply?

Once you’ve submitted your initial application for LTC benefits, here’s what comes next:

Icon List Group
What happens after I apply
Registered nurse

We may contact you for additional information, or conduct an on-site assessment at your home by a registered nurse.

Contact Us

If, after submitting the required forms and medical records, three weeks go by without receiving a decision letter from us, contact us to check your application status.

Letter

We will send you a letter confirming our eligibility decision after we receive all required forms and medical information.

Approval: If your application is approved, the letter will confirm the first date you are eligible for reimbursement for covered services.

Denial: If your application is denied, the letter will confirm the reason for the denial.

Appeals: You have the right to appeal our decision by sending a written request for review to us no later than 60 days after the date of the letter. After our review is complete, we’ll send you a written notice of our decision. If we uphold the initial denial and you wish to pursue your request further, you may file an appeal at that time.

Call for assistance or help

© 2024 WEA TRUST

Cookies UI