Sample Long Term Care Insurance Policy, Page 19

SAMPLE POLICY

PART 4 - CLAIMS
This part explains when to file Your claim, the information We need to review, process and pay Your claim, and Your and Our rights and responsibilities. Early notification to Our Claims Department will facilitate a timely review of Your claim. Please
let Us know immediately or in advance, whenever possible, when You need care or services covered by this Policy. Please call Us at 1-800-377-7311.

HOW AND WHEN TO FILE A CLAIM
Notice of Claim
To file a claim You must first notify Us that You are currently receiving or plan to receive Long-Term Care Services covered by Your Policy.

You can notify Us by:
• writing to Us at Our LTC Administrative Office or contacting Us at Our website address -
www.jhancock.com; or
• calling Us at Our LTC Administrative Office at 1-800-377-7311.
Your notice must include:
• Your name;
• Your Policy number; and
• the type of care You are receiving or plan to receive.

If You send Us written notice, Your notice must be mailed to Us postmarked within 45 days after
Long-Term Care Services begin, or as soon as reasonably possible. If You notify Us by telephone, You must call Us within 45 days after a covered loss begins or as soon as reasonably possible. We will confirm, in writing, Your notification within 15 days after We receive such notification.

Claim Forms and Proof of Loss
When We receive Your notice of claim, We will send You claim forms for filing a Proof of Loss. You must file Your Proof of Loss with Our LTC Administrative Office.
Proof of Loss means detailed written documentation acceptable to Us which describes and confirms: Your inability to perform two or more of the Activities of Daily Living or Your Cognitive Impairment; Your confinement in a Nursing Home or Assisted Living Facility; or other care (e.g., Home Health Care, Respite Care, Care Advisory Services) You are receiving.

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