This document summarizes 21 cases against Senior Health Insurance Company of Pennsylvania over claim handling issues related to long-term care insurance policies. The majority of cases involved delays in processing or paying claims for long-term care. A few cases also involved customer service issues and concerns about how benefits were being accounted for. The cases were opened between 2011 and 2018 in California and involved both individual and group long-term care insurance policies.

1. Case Index
Case Count: 21 Entity Count: 1
Case # Open Date Close Date Div. Cov. Type Reason Category Description Violation
Senior Health Insurance Company of Pennsylvania (NAIC# 76325)
1049749 06/06/2018 07/09/2018 CA Individual Claim Handling Claim issues.
* 1049749 04/20/2011 05/27/2011 CA Individual Claim Handling Claim issues.
1159468 11/19/2013 12/27/2013 CA Individual Claim Handling The consumer is requesting payment of his wife's long term care claims.
1221797 09/25/2014 10/21/2014 CA Individual Claim Handling The consumer needs the insurance company to process their claims.
Everything has been sent in to them that needed to be sent.
WAC 284-30-650
1253773 01/22/2015 02/13/2015 CA Individual Claim Handling a LTC claim delay on her father's policy
1266500 07/23/2015 08/04/2015 CA Individual Claim Handling; Claim
Handling
Concerns re: company's accounting of parent's LTC benefits
* 1266500 03/30/2015 04/24/2015 CA Individual Claim Handling; Claim
Handling
Concerns re: company's accounting of parent's LTC benefits
1287379 07/16/2015 08/11/2015 CA Individual Claim Handling Coverage and claim processing delay
1290389 08/03/2015 09/01/2015 CA Individual Claim Handling Claim denials for care received in an Adult Care Home.
1347199 01/29/2016 01/29/2016 CA Inquiry about the company and about protections for financial insolvency
1399770 10/24/2016 11/07/2016 CA Individual Claim Handling;
Policyholder Services
Claim delay - possible long term care insurance. Reopened case due to
additional questions the consumer wants addressed.
* 1399770 09/11/2016 10/04/2016 CA Individual Claim Handling Claim delay - possible long term care insurance. Reopened case due to
additional questions the consumer wants addressed.
1451330 02/23/2017 03/14/2017 CA Individual Claim Handling claim processing delay issue
1465540 04/18/2017 06/15/2017 CA Individual Claim Handling Long term care benefits delay
1469521 06/14/2017 07/07/2017 CA Individual Claim Handling Claims processing delay.
* 1469521 05/03/2017 05/25/2017 CA Individual Claim Handling Claims processing delay.
1487420 07/11/2017 08/11/2017 CA Individual Policyholder Services Mr. Garnett is questing that the Senior Health Insurance Company of
Pennsylvania acknowledge receipt of his coverage change request.
1503427 09/19/2017 10/10/2017 CA Individual Policyholder Services Long term care coverage
1534386 12/13/2017 01/03/2018 CA Individual Claim Handling company not paying claims on long-term care policy
1535670 12/19/2017 01/09/2018 CA Individual Claim Handling Long term care delay
1544503 01/16/2018 02/16/2018 CA Individual Claim Handling Customer service issues with being responsive.
1565552 04/10/2018 05/01/2018 CA Individual Claim Handling a claim delay issue on a situs Tennessee policy
1565706 04/11/2018 05/08/2018 CA Individual Policyholder Services Long term care
1578237 06/06/2018 CA Individual Claim Handling long-term claim delays
Kristy Bell 7/18/2018 11:06:01 AM Page 1 of 3

2. Case # Open Date Close Date Div. Cov. Type Reason Category Description Violation
* 1578237 06/01/2018 06/04/2018 CA long-term claim delays
1587364 07/13/2018 CA long term care
Note: An asterisk (*) indicates that the Case # has already appeared on the report under a different Entity. The asterisk only appears on second and subsequent Case # appearances.
Kristy Bell 7/18/2018 11:06:01 AM Page 2 of 3

3. Selection Criteria:
NAIC #: 76325
Open Date: 07/18/2013 to 07/18/2018
Kristy Bell 7/18/2018 11:06:01 AM Page 3 of 3