Please note the following:

  • Please contact us in advance to discuss care provider options available in your policy.
  • Claim forms must be submitted after Long-Term Care (LTC) services have begun
  • The Policy number(s) must be indicated on the LTC Claim Form and Attending Physician's Statement
  • Page 4 of the LTC Claim Form (authorization) must be signed & dated

Step one (Required): LTC claim form

This form should be completed by the Policyowner and Claimant or the Policyowner and Claimant's legal representative (e.g. Power of Attorney, Guardian, or Conservator). This form is utilized whether your policy includes Long-Term Care language or Convalescent Care language.

Please note: If the policy is owned by a trust, or a legal representative is involved in the claim, a complete copy of the trust or legal representative document is required.

You will want to have the following information ready to successfully complete the form:

  • Policy number(s)
  • The name, address, and phone number of the claimant’s physician(s)
  • The name, address, and phone number of the claimant’s long-term care provider(s)
  • Type of service(s) the claimant is receiving (home health care, assisted living, and/or skilled nursing)
  • The date long-term care services began with the care provider(s)
  • Why the claimant is receiving long-term care services

See an example of a completed form before you start.

LTC claim form

Step two (Required): Attending physician's statement

This form should be completed by the physician most knowledgeable about the Long-Term Care condition related to this claim.

Attending physician's statement

Step three (optional): Direct deposit

This form should be completed if you want claim(s) payments deposited directly into the Policyowner's account.

Direct deposit form

Step four (Required): Submit claim forms

There are three options for submitting the above claims documentation:

  • Submit by email

  • Submit by fax

    (317) 285-5239

  • Submit by mail

    OneAmerica Financial Partners, Inc.
    Long-Term Care Claims
    P.O. Box 6008
    Indianapolis, IN 46206-6008

Please note: An e-mail message sent to one of these oneamerica.com e-mail addresses is not secure. To securely send information to us, please utilize secure-oneamerica.com. Once you click that link, click on “Register” under “New to secure e-mail?” and follow the prompts. Once you register and create a secure mailbox, you will be able to exchange secure e-mails with the companies of OneAmerica Financial.

What happens next?

  • Alzheimer's helpline

    Please click below for information regarding the Alzheimer’s Association Helpline. This free service offers confidential support and information to those living with the disease, caregivers, and family members.

    Helpline info

  • Once the documentation is received, a Care Specialist will be assigned to review the claim forms. The Care Specialist will contact the insured/annuitant or his/her legal representative to proceed with the initial claim interview and discuss the claim process.  

     

    For more detailed information regarding the claim process, please review the Frequently Asked Questions (FAQ) document.

Note: OneAmerica Financial℠ is the marketing name for the companies of OneAmerica. Products issued and underwritten by The State Life Insurance Company® (State Life), Indianapolis, IN, a OneAmerica company that offers the Care Solutions product suite.