Calpers Long Term Care Form – Fill Out and Use This PDF

Calpers Long Term Care Form PDF Details

Navigating the complexities of long-term care can be daunting, especially when dealing with the intricacies of filing a claim. The California Public Employees' Retirement System (CalPERS) Long-Term Care Claim Form, denoted as CLM-001, serves as a comprehensive guideline intended to simplify the claim filing process for members.

Four-Step Claim Submission Process

The CalPERS long-term care claim follows a structured four-step process:

1. Contact the CalPERS Intake Team to initiate your claim and receive a list of required documents.
2. Submit an authorization form if a representative will act on your behalf throughout the claim.
3. Complete the CLM-001 claim form with information from you and your care providers.
4. Submit all required documentation, including care plans, itemized bills, and provider qualifications.

Documentation Required by Care Setting

CalPERS requires specific documents depending on the type of care you receive:

• Nursing home or assisted living: itemized bills, a copy of the care plan, and a facility license.
• Home health care: provider credentials, a schedule of visits, and detailed care records.
• Hospice or adult day care: physician certification of medical necessity and a written care plan.

Common Reasons for Claim Delays

Incomplete or inaccurate documentation is the most common reason for claim processing delays. Submitting itemized bills, current care plans, and complete provider qualification records from the start helps avoid delays. The CalPERS Long-Term Care team is available to answer questions about covered services, provider qualifications, and reimbursement details at every stage.

Related CalPERS Forms

Members often need additional CalPERS documents alongside this claim form. You may also require the CalPERS Beneficiary Designation Form to update your listed beneficiaries, or the CalPERS Retirement Application Form if you are approaching retirement. Members receiving care payments should also review the CalPERS Direct Deposit Authorization Form.