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Insurance Claims

Long Term Care (LTC)

Qualifications: If you are unable to perform 2 out of 6 activities of daily living (bathing, dressing, feeding, toileting, transferring, continence), or you have a cognitive impairment, you qualify for the Long Term Care benefit.

The lost of these functions could be due to a physical condition or mental disorder resulting from an injury or illness such as Alzheimer's disease, or because of advanced aging.

Benefits verification: read your Summary of Benefits carefully for explanations and descriptions of the benefits you are entitled to.

  • Plan 1: State Licensed Nursing Facility or Professional home care
  • Plan 2: State Licensed Nursing Facility or Total home care
  • Plan 3: State Licensed Nursing Facility or Professional home care plus 5% inflation protection
  • Plan 4: State Licensed Nursing Facility or Total home care plus 5% inflation protection.

How Do I Get Started

  1. Complete the following forms:
    1. Group Long Term Care Disability Claim Form
    2. L.A. City Employee's Club Authorization For Release of Information Form
    3. If you have Kaiser Permanente, please complete the Kaiser Authorization for Release of Information Form.


    If you prefer, you may request this form from us via e-mail, or you may call us at (800) 464-0452.
  2. Submit the form to:

    UNUM Long Term Care Benefits
    2211 Congress Street
    Portland, Maine 04122-2300
  3. The Insurance Company will request information from your doctor, gather the information received, review it and make a determination. During this process, the Insurance Company will keep in touch with you. This decision making process takes between 5 to 6 weeks. If you want to contact the Insurance Company, please call (800) 693-4988.
  4. Contact us by phone: 1-800-464-0452

Do You Have Your Forms Yet?

Need Help?

We Can Help.

Call us at 1-800-464-0452 or email us at claims@cityemployeesclub.com to speak to our claims department.

 
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