Questions & answers · Long-term care insurance

Question about my long-term care insurance claim for an illness or injury

Long-term care insuranceHow to fileTexasChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: Texas Insurance Code · Chapter 1201 · § 1201.105(a) (Minimum Standards for Benefits for Long-Term Care) View original ↗

In short

Send written notice before the 21st day after the loss.
If paid month by month, proof of loss is due before the 91st day after that pay period ends.
What counts as covered care comes from your policy's own words, not from this claim filing rule.

What this means

Texas sets the claim-filing clock for an individual health policy. Long-term care cover falls under that same chapter [1]. Written notice of a claim is due before the 21st day after the loss, or as soon after as you reasonably can [2]. Paid periodically? Then written proof of loss is due before the 91st day after that pay period ends [3].

What counts as covered care is a separate question — home care, nursing, or something else. The state sets minimum benefit standards for long-term care cover [1]. But it is your own policy's "benefit trigger" words that decide what your plan pays for.

Your next step

Send written notice before the 21st day after the loss, if you haven't already [2]. If your benefit is periodic, proof of loss is due before the 91st day after the benefit period ends [3].

Check it yourself

Read the definitions page of your policy. Find the "benefit trigger." It is often written as needing help with a set number of daily activities. It can also be written as a loss of thinking skills.

Where this comes from (3)

[1] Texas Insurance Code · Chapter 1201 · § 1201.105(a) (Minimum Standards for Benefits for Long-Term Care) · checked 2026-11-06
The commissioner shall adopt rules establishing minimum standards for benefits for long-term care coverage under individual, group, and blanket accident and health insurance policies and certificates delivered or issued for delivery in this state.
[2] Texas Insurance Code · Chapter 1201 · § 1201.211(a) (Policy Provision: Notice of Claim) · checked 2026-11-06
Notice of Claim: A written notice of claim must be given to the insurer before the 21st day after the date of the occurrence or beginning of any loss covered by the policy, or as soon after that date as is reasonably possible.
[3] Texas Insurance Code · Chapter 1201 · § 1201.213 (Policy Provision: Proof of Loss) · checked 2026-11-06
For a claim for loss for which this policy provides any periodic payment contingent on continuing loss, a written proof of loss must be provided to the insurer at the insurer's designated office before the 91st day after the termination of the period for which the insurer is liable.

How we found this

We matched your question to 3 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.

What we don’t know yet

Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.

Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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