Illinois Administrative Code
Title 50 - INSURANCE
Part 2012 - LONG-TERM CARE INSURANCE
Exhibit I - Claims Denial Reporting Form: Long-Term Care Insurance
Instructions
The purpose of this format is to report all long-term care claim denials under in force long-term care insurance policies. "Denied" means a claim that is not paid for any reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition.
|
State Data |
Nationwide Data1 |
|
1 |
Total Number of Long-Term Care Claims Reported |
|
2 |
Total Number of Long-Term Care Claims Denied/Not Paid |
|
3 |
Number of Claims Not Paid due to Preexisting Condition Exclusion |
|
4 |
Number of Claims Not Paid due to Waiting (Elimination) Period Not Met |
|
5 |
Net Number of Long-Term Care Claims Denied for Reporting Purposes (Line 2 Minus Line 3 Minus Line 4) |
|
6 |
Percentage of Long-Term Care Claims Denied of Those Reported (Line 5 Divided By Line 1) |
|
7 |
Number of Long-Term Care Claims Denied due to: |
|
8 |
* Long-Term Care Services Not Covered under the Policy2 |
|
9 |
* Provider/Facility Not Qualified under the Policy3 |
|
10 |
Benefit Eligibility Criteria Not Met4 |
|
11 |
* Other |
1 The nationwide data may be viewed as a more representative and credible indicator where the data for claims and denied for your state are small in number.
2 Example - home health care claim filed under a nursing home only policy.
3 Example - a facility that does not meet the minimum level of care requirements or the licensing requirements as outlined in the policy.
4 Example - a benefit trigger not met, certification by a licensed health care practitioner not provided, no plan of care.
