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CalPERS Long-Term Care Program fax number

(866) 294-6967

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CalPERS Long-Term Care Program

Used for: Long-Term Care claim submission and related documentation by fax or mail to CalPERS Long-Term Care Program; processing of claims includes time sheets, eligibility assessments, benefit packets, direct deposit forms, and assignment of benefits.

Fax destination details

Department
CalPERS Long-Term Care Program
Purpose
Long-Term Care claim submission and related documentation by fax or mail to CalPERS Long-Term Care Program; processing of claims includes time sheets, eligibility assessments, benefit packets, direct deposit forms, and assignment of benefits.
Form
CLM-001 Online Claim Form LTCG — Long-Term Care Claim Form
Address
CalPERS Long-Term Care Program, P.O. Box 64902, St. Paul, MN 55164-0902
Voice phone
1-800-982-1775

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  • Keep the delivery confirmation with your submission records.

Submit the Long-Term Care Claim Form (CLM-001) and any supporting documents by mail or fax to CalPERS Long-Term Care Program. The packet may include a Direct Deposit Form and an Assignment of Benefits form.

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