If you're using long-term care insurance to help pay for in-home care, you may want your insurance company to send payments directly to your home care provider rather than reimburse you afterward.
An Assignment of Benefits (AOB) form allows you to request this arrangement.
To make the process easier, 24 Hour Caregivers offers a free, fillable Assignment of Benefits form for long-term care insurance that you can download, complete, and submit to your insurance company.
Download the Free Assignment of Benefits Form (Fillable PDF)
Important: This is a general template provided by 24 Hour Caregivers, not an insurer-issued form. Check with your insurance company to confirm it accepts this document before submitting it.
What Is an Assignment of Benefits for Long-Term Care Insurance?
An Assignment of Benefits is an authorization that allows an insurance company to pay eligible benefits directly to a care provider instead of sending reimbursement payments to the policyholder.
For families arranging home care, this can simplify how insurance payments are handled and reduce the need to pay the full cost of care upfront while waiting for reimbursement.
However, signing an AOB does not guarantee that your insurance company will approve the arrangement or cover all care expenses. Payments remain subject to your policy's terms, coverage limits, and claim approval.
Download Your Free Assignment of Benefits Form
Our free long-term care insurance Assignment of Benefits form is a one-page, fillable PDF designed to make the authorization process easier.
The form includes fields for:
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Policyholder name and insurance policy or claim number
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Home care agency name and contact information
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Provider payment mailing address
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Authorization for direct insurance payments
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Policyholder or authorized representative signature
You can enter the requested information electronically, then print the form for a handwritten signature.
How to Fill Out the Assignment of Benefits Form
Completing the form is straightforward. Before getting started, have your long-term care insurance information and your home care provider's details available.
1. Enter the policyholder's information
Provide the insured person's full legal name and long-term care insurance policy or claim number. Make sure the information matches the insurance company's records.
2. Add the home care provider's details
Include the agency's legal name, federal Employer Identification Number (EIN), payment mailing address, and contact information. Your home care agency can provide these details.
3. Review the authorization
Read the authorization carefully. By signing, you are requesting that eligible insurance benefits be paid directly to the provider listed on the form.
You remain responsible for charges your insurance does not cover under your agreement with the provider.
4. Sign and date the form
The insured person or an authorized legal representative must sign the document by hand. Include the signer's printed name and, if applicable, their relationship or legal authority.
5. Confirm how to submit the form
Contact your long-term care insurance company to verify that it accepts the document. Ask whether any additional paperwork is required and use the insurer's approved secure submission method.
Will My Long-Term Care Insurance Company Accept This Form?
Not all long-term care insurance companies accept third-party Assignment of Benefits forms. Some have their own documents and procedures for setting up direct payments.
Depending on your insurer, you may also need:
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An insurer-specific Assignment of Benefits form
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A completed W-9 from your home care provider
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Additional policy or claim documentation
It's best to check these requirements before submitting anything.
If you're still learning how your policy works, our guide on whether long-term care insurance covers 24-hour home care explains common coverage requirements, benefit limits, and documentation.
Frequently Asked Questions
Can long-term care insurance pay my home care agency directly?
Yes, some long-term care insurance policies allow eligible benefits to be paid directly to an approved home care provider. The arrangement depends on your insurer's requirements and approval.
Is an Assignment of Benefits form required for long-term care insurance?
Not always. Some insurers reimburse policyholders directly, while others allow payments to be assigned to a care provider. Contact your insurer to determine which option is available under your policy.
Can I cancel an Assignment of Benefits?
The 24 Hour Caregivers template allows you to revoke the authorization in writing, subject to the insurance company's requirements. Contact your insurer to confirm the appropriate cancellation process.
Need Help Using Long-Term Care Insurance for Home Care?
Dealing with insurance paperwork can be frustrating, especially when you're also arranging care for a parent or loved one.
At 24 Hour Caregivers, we help families understand their long-term care insurance options, coordinate required documentation, and navigate the claims process.
Our team can also help you explore how your policy may apply to the in-home care services your loved one needs.
Learn more about our long-term care insurance assistance, or call (866) 681-7778 to speak with our team.
Disclaimer: The information provided in this article is for general informational and educational purposes only and is not intended as medical advice or a substitute for professional healthcare guidance. Always consult a qualified healthcare professional regarding any medical condition, treatment, or healthcare decision.
