Agent Guide | Home Health Care
Applications & Forms
Completion instructions for the application included in this Agent Guide. Pages 1-7 must be completed in its entirety. A copy of the completed application will be made by ManhattanLife and attached to the policy to make it part of the contract.
Application
Prescription Drug Claim Form
Used by a policyholder to make a claim against the policy for prescription drug benefits.
HHC Standard Benefits Claim Form
Often referred to as the “Home Health Care Claim Form”. Used by a policyholder to make a claim against the policy for Home Health Care and home health care aide benefits. Often referred to as the “Physician Certification Claim Form”. Used by a physician to certify that a policyholder can no longer complete Activities of Daily Living and is eligible for Home Health Care and/ or Home Health Care Aide services.
Physician’s Home Health Certification
Submitting New Business Prior to submitting applications: •Review application for completeness and accuracy •Verify correct premium amount •Collect bank draft authorization information and signature(s) as applicable •Any corrections must be initialed/dated by the applicant/owner (do not use white-out) Effective Dates
The policy effective date and the bank draft date must match for a policy to be issued. If the requested effective date is left blank, the bank draft date will become the policy effective date. We will honor requests for effective dates starting from the date the application was signed up to six months in the future. Insurance policies may not be effective on the 29th, 30th or 31st of the month. Applications written on these days will be made effective on the 1st of the following month. Additionally, the policy effective date cannot be prior to the applicant’s signature date. Once an application is processed and accepted, the policy is scheduled to draft on the requested effective date.
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