Serving Orange County & the Coachella Valley · CA Licensed HCO #304700544
Using Your CalPERS Long-Term Care Benefits for Care at Home
Some existing CalPERS Long-Term Care policies may help pay for eligible care at home when the participant meets the policy’s benefit and provider requirements. The CalPERS Long-Term Care Program is administered by illumifin. Golden Age Companions can provide licensed non-medical home care and help organize provider records and invoices, but CalPERS and illumifin determine coverage and claim eligibility.
Administered by: illumifin (third-party administrator for the CalPERS Long-Term Care Program)
I have a CalPERS policy and need home care
Request a no-cost policy review conversation, or call and speak with someone who has handled long-term care documentation before.
The claims process, step by step
What to do at each stage of a CalPERS home care claim, and what documentation we supply. Jump straight to the stage you are on.
Who this page is for
- Policyholders
- Adult children managing a parent’s care
- Spouses
- Powers of attorney
- Conservators and fiduciaries
- Insurance agents
- Financial advisors
- Elder-law attorneys
- Hospital and rehabilitation discharge professionals
- Care managers
What the official CalPERS material says
Summarized from the official sources listed at the bottom of this page. Requirements vary by policy form — always confirm against your own policy.
Who administers the program
CalPERS sponsors the Long-Term Care Program for California public employees, retirees, and eligible family members. Day-to-day servicing — certificate questions, claim intake, benefit determinations, and payments — is handled by the program’s third-party administrator, illumifin. Families are generally directed to the program’s service line rather than to a local CalPERS regional office for claim matters.
How a claim is started
- Contact the CalPERS Long-Term Care Program service line to open a claim and confirm the certificate is in force.
- The program collects information about the participant’s current functional and cognitive status.
- A care assessment is arranged to evaluate whether the benefit trigger under the certificate is met.
- A plan of care is developed and reviewed by the administrator.
- Once benefits are approved, covered services are billed and documented on an ongoing basis.
Provider requirements and documentation
CalPERS Long-Term Care certificates describe the categories of provider whose services may be eligible. In California, home care agencies are licensed as Home Care Organizations and their caregivers are registered Home Care Aides. Expect the administrator to request the agency’s license information, tax identification, and itemized invoices showing dates, hours, caregiver, and services delivered.
Enrollment in the CalPERS Long-Term Care Program is closed to new applicants; this page is written for families who already hold a certificate.
For existing CalPERS Long-Term Care policyholders
Most of the families who reach us about CalPERS bought the coverage decades ago — a teacher, a county employee, a state worker who signed up during an open-enrollment window and filed the paperwork away. The person who bought it is now in their eighties, the certificate is in a drawer, and nobody is certain what it covers.
Start with the certificate itself. Benefit amounts, elimination periods, inflation protection, and the provider categories that qualify all vary by the year of purchase and the options that were elected. Two CalPERS participants in the same Orange County neighborhood can hold certificates with materially different home care terms.
The role of illumifin
illumifin is the administrator that receives claim forms, coordinates the care assessment, issues benefit determinations, and processes payment. When we prepare documentation for a CalPERS family, it is generally illumifin — not CalPERS itself — that receives the invoices and provider records.
Only the administrator can tell you what your certificate requires. We do not interpret certificate language or predict determinations.
Preparing for the care assessment
- Write down, in plain language, what the person cannot safely do alone — bathing, dressing, toileting, transferring, continence, eating.
- Note cognitive changes concretely: missed medications, leaving the stove on, wandering, repeated calls at night.
- Have the primary physician’s name, phone number, and recent visit dates ready.
- Have a family member present who sees the person on ordinary days, not only on good days.
- Do not coach or exaggerate. Assessors are experienced, and an inaccurate picture helps nobody.
Submitting itemized home care invoices
Home care invoicing for an LTC claim is more detailed than a normal family invoice. Ours show the certificate holder’s name, the service dates, the start and end time of every shift, the caregiver, the hourly rate, and the services delivered on that shift, together with our Home Care Organization license number and tax identification.
We keep these records for the length of the engagement so that recertification requests and retroactive documentation requests can be answered without reconstructing months of care from memory.
Information for public-employee retirement advisors and fiduciaries
We work regularly with fiduciaries, conservators, elder-law attorneys, and retirement advisors whose clients hold CalPERS certificates. When written authorization is in place, we can supply provider documentation directly to the authorized representative and keep a single point of contact for the file.
What Golden Age Companions can help with
We do
- Providing licensed non-medical home care across Orange County
- Supplying Home Care Organization licensing and business documentation
- Preparing itemized invoices in the detail LTC claims require
- Maintaining care records and caregiver shift documentation
- Coordinating provider documentation the carrier requests
- Helping the family organize claim paperwork and keep track of what has been sent
- Communicating with the carrier when written authorization is provided
- Supporting an assignment-of-benefits request when the carrier permits it
- Maintaining documentation for ongoing reimbursement and recertification
We do not
- Determine benefit eligibility
- Interpret policy language
- Guarantee claim approval
- Guarantee reimbursement
- Represent the insurance carrier
- Sell insurance
- Provide legal, tax, or financial advice
Golden Age Companions is a licensed Home Care Organization (License No. 304700544), not an insurance company, agency, or adviser.
Documents a family may need
- CalPERS Long-Term Care certificate or participant number
- Participant’s full legal name, date of birth, and current address
- Authorized representative or power-of-attorney documentation
- Program authorization form permitting the agency to speak with the administrator
- Physician or licensed-practitioner certification of need
- Plan of care produced after the assessment
- Home Care Organization license information for the agency
- Agency W-9 / tax identification
- Itemized invoices with dates, shift times, hours, and services
- Caregiver shift notes and care records
- Proof of payment, when the certificate requires it
Requirements vary by policy and carrier. This list is a starting point, not a determination of what your policy requires.
Questions to ask CalPERS
- What is the daily, weekly, or monthly home care benefit?
- Is this a reimbursement policy or an indemnity policy?
- What is the remaining benefit pool?
- Is there an inflation rider, and how does it apply?
- What benefit trigger applies to this policy?
- What is the elimination period?
- Does the elimination period count calendar days or service days?
- Does the policy require a licensed home care agency?
- What provider documentation is required?
- Are itemized invoices required, and in what format?
- Is proof of payment required?
- Is direct provider payment available?
- Is assignment of benefits permitted?
- How often must invoices be submitted?
- How frequently is recertification required?
These questions should be answered by the carrier, its administrator, or a licensed insurance professional — not by a home care agency.
Referring a client with a CalPERS long-term care policy
Public-employee retirement advisors, fiduciaries, and elder-law attorneys frequently manage CalPERS certificates on behalf of a client who can no longer manage the paperwork.
When authorized and applicable, we can provide:
- HCO License No. 304700544
- Provider contact information
- W-9
- Certificate of insurance
- Workers’ compensation documentation
- Care plan information
- Itemized invoices
- Shift documentation
- Secure administrative communication
- A clear, named point of contact