Forms & Carrier Information
An authorization form allowing the carriers to share your health history and related health information with a third party, whom you’ve designated require carrier specific forms. See below for the specific form that your carrier requires given HIPAA.
These forms are provided for reference. We encourage you to call your carrier for any updates on specific authorization requirements.
If a provider doesn’t have a form below, then unfortunately, they do not provide a blank form to be kept on hand as forms are updated regularly. If, at any time, you need an authorization form they will gladly provide the form to the policy holder.
Provider / Policy Holder Customer Service Number
- Brighthouse Financial
login.brighthousefinancial.com/login.do
Individual long-term care servicing support – (888) 507-9185
Individual long-term care claims – (877) 582-7767 - Genworth – (800) 456-7766
www.genworth.com - John Hancock – (800) 377-7311
www.johnhancock.com/sign-in.html - Lincoln MoneyGuard – (800) 962-1654 ext. 5539
www.lincolnfinancial.com/public/individuals/support/customerservice/annuityresources/myaccount - NY Life Life – (800) 695-9873
www.mynyl.newyorklife.com/VSCRegWebApp/login - NY Life LTC – (800) 224-4582
- Mass Mutual – (888) 505-8952
www.massmutual.com - MedAmerica – (800) 724-1582
- MetLife – (888) 565-3761
metlife-prod.adobecqms.net/ltc/ - Mutual of Omaha – (877) 894-2478
www.mutualofomaha.com/welcome/customer-access - Nationwide – (800) 547-7548
www.nationwide.com/account-login
- Prudential – (800) 732-0416
www.prudential.com/login - State Life / OneAmerica – (800) 537-6442
www.oneamerica.com/register
www.oneamerica.com/login - TransAmerica – (800) 227-3740
www.transamerica.com/login