Individual Long-Term Care (LTC) Insurance

long term care ltc Long-Term Care is the type of care received either at home or in a facility, when someone needs assistance with activities of daily living, such as bathing and dressing due to an accident, an illness or advancing age.

Rising life expectancy means that the potential need for "long-term care" grows with every passing year of your life. The likelihood is that you or a member of your family will need long-term assistance due to a prolonged illness, a disability, or general deterioration of your health and ability to perform routine daily activities. Most long term care expenses are not covered by Social Security or Medicare, Medicare Supplement ("Medigap"), or private health insurance. Medicaid pays for nearly half of all nursing home care, but you must meet federal poverty guidelines and may have to "spend down" most of your assets on health care.

Individual Long-Term Care Insurance Quote Request

Please take a moment to fill out the form below and one of our local insurance agents will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.

* Required fields.

General Information
Name: *
Address:
City:
State:	Zip:
Phone: *
Best Time To Call:	AM PM
E-mail Address: *

Current LTC Insurance Information
Carrier (Company) Name (not agency):
Policy Expiration Date:	Premium Amt: $
Years Insured:
Please give a brief description of your current LTC insurance plan:

Coverage Options
Type of Coverage:	New Coverage Additional Coverage Replacement
Waiting Period:
Daily Benefit Amount:
Benefit Period:
Inflation Protection:
Do you want your policy to include home-health care coverage?	Yes No

Information About You & Your Spouse
Please enter information below for all to be covered.
	SELF	SPOUSE
Name:	Self
Date of Birth:
Sex:	M F	M F
Marital Status:	M S	M S
Occupation:
Height:	ft. in.	ft. in.
Weight:	lbs.	lbs.
Smoker:	Yes No	Yes No
Have you had any of the following health conditions:	Heart Cancer Diabetes HBP	Heart Cancer Diabetes HBP

Additional Comments or Questions

Briefly describe any medical events in the past 10 years that have required hospitalization or surgery for either you or your spouse:

Additional Comments or Questions

Enter Security Code:

Please click the "Submit Quote Request" button to send your quote request. No coverage is in effect until bound by an insurance carrier. This is a request for quotation only.

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