Forms & Carrier Information
To authorize carriers to share your health history and related information with a designated third party, specific carrier forms are required. Below, you’ll find links and contacts for each carrier’s specific HIPAA-compliant authorization form. These forms are provided for reference purposes. We recommend contacting your carrier directly to confirm the most current authorization requirements.
If a carrier does not list a form below, it means they do not provide a blank form due to regular updates. If you need an authorization form, the carrier will provide it directly to the policyholder upon request.
Provider / Policy Holder Customer Service Number
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- 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/myaccount
- Mass Mutual – MassMutual to transition its LTCi Administration
MassMutual will transition the servicing of SignatureCare, its stand-alone long-term care insurance (LTCi) policies, from LifeCare to Davies Life & Health on Nov 4, 2024.
- New Address: P.O. Box 7066, Allentown, PA 18105-7066
- Email: DLHSupport@us.davies-group.com
- Fax: 877-855-7816
- Phone: 888-505-8952
- 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
- NY Life – (800) 695-9873
www.mynyl.newyorklife.com/login
- NY Life LTC – (800) 224-4582
- 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
- Brighthouse Financial
