Ill. Admin. Code tit. 50, pt. 2012, exh. I
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.
Ill. Admin. Code tit. 50, pt. 2012, exh. I