Get Calpers Long Term Care Form - Fill Out And Sign Printable ...

Completing the Calpers Long Term Care Form is essential for securing home care services. This guide will provide clear, step-by-step instructions to help you accurately fill out the form online.

Follow the steps to complete your long-term care form successfully.

1. Click the 'Get Form' button to obtain the form and open it in the editor.
2. Fill in your personal information, including your name, contact details, and the coverage ID number. This information is necessary to identify your claim and process the form correctly.
3. Provide details about the independent provider, including their name, contact number, and address. You will also need to attach a copy of their government-issued photo ID.
4. Indicate whether the independent provider is related to you and if they reside in your home. This ensures compliance with the program's guidelines.
5. Complete the training and skills section by providing information on the provider’s qualifications. Attach any necessary documentation, such as licenses or certifications.
6. Outline the schedule of services, detailing the specific days and hours the independent provider will work. Accurate reporting is essential for reimbursement.
7. Review and sign the form to confirm that all information provided is accurate to the best of your knowledge. Both the claimant and the independent provider must sign the document.
8. Submit the completed form via fax to 1-866-294-6967 or mail it to CalPERS Long Term Care Program. Ensure you keep copies of all disclosures for your records.
9. After submission, wait for confirmation regarding your eligibility for benefits, and maintain open communication with your care manager about any changes.
10. Finally, after receiving approval, track and submit necessary documentation for reimbursement as needed, adhering to the guidelines discussed in the program.

Start filling out your Calpers Long Term Care Form online today to ensure timely care services.