Get Long Term Care Continuing Claim Form - Aflac

Filling out the Long Term Care Continuing Claim Form - Aflac online is a straightforward process. This guide provides clear instructions to help you complete the form accurately, ensuring timely processing of your claim.

Follow the steps to fill out the Long Term Care Continuing Claim Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by entering the cancer policy number and long-term care policy number at the top of the form.
3. In the 'Patient Information' section, clearly print the first name, middle initial, and last name of the patient.
4. Indicate the relationship of the patient to the primary policyholder, selecting from options such as spouse, dependent child, or other.
5. Select the patient's sex and enter their birth date in the format MM/DD/YYYY.
6. Provide the confinement dates for the period of care, ensuring that both start and end dates are correctly entered.
7. Record the initial date of admission to the facility and the room rate per day.
8. Indicate the sections of the facility where the patient was confined by selecting appropriate options, such as skilled nursing or assisted living.
9. If applicable, answer whether the patient was confined to a hospital during this period, and list the admission and discharge dates.
10. Indicate if there were any bedhold days during this period, providing dates if yes.
11. Include the signature, title, and date of the nursing home personnel completing the form.
12. Provide the institution's name, address, Tax ID number, and phone number.
13. Review all entries for accuracy, then save any changes, and prepare to download, print, or share the completed form.

Complete your Long Term Care Continuing Claim Form online today to ensure prompt processing of your claim.