Determining Benefit Eligibility

Kehilla Care reserves the right to Independently determine, by examination of a Health Care Professional, the severity of any ADL deficits or cognitive impairment. This eligibility process can take several weeks, depending on the amount of information (and its availability) needed to determine your benefits eligibility date. This is the date when you started needing long term care assistance, according to the sharing program.

We’ll send you a written notice of our decision on whether or not you are eligible for benefits no later than 10 business days after we receive all of the requested information.

  • If your benefit eligibility is approved, a care coordinator will call you, and you’ll receive a letter stating the date you are eligible for benefits. The letter will include necessary benefit instructions and forms that you can use for the submission of invoices and/or proof of payment. These benefit forms are also available to download online.
  • As part of this process, we’ll assign a team of care coordinators to work with you and your family members to develop a plan of care that meets your individual needs. Our care coordinators can also help you find high-quality care providers in your area; monitor the care you are receiving; and assist with changing your plan of care as your needs change.
  • If your benefit eligibility is denied, a care coordinator will call you, and you’ll receive a letter stating the reason for the denial. If you still feel strongly that you’re eligible for the benefits of your plan, you may request a review of the denial by sending a written request to us no later than 60 days after the date of the denial. After our review is completed, we’ll send you a written notice of our decision. If we uphold the initial denial, at that time you may request an appeal.