Long Term Care Insurance

But she did,
and I did too!
(Please note: Not all pre-existing conditions are insurable. Full disclosure and underwriting will determine if you are eligible for coverage.)

::Real Life Stories...............

Long Term Care Insurance plans are extremely flexible in benefits and give everyone an opportunity to have some type of coverage.

Medicare helps provide up to 100 days (conditions must be met) of skilled nursing facility care, it doesn’t cover custodial care for personal needs.

If you have any questions while reviewing this information, feel free to give me a call and we can discuss this over the phone, or set up a time to meet to review it in as much detail as you feel comfortable with your decisions.

Lorraine Spiotta, CLU,ChFC
Certified Long Term Care Insurance Strategist
(732) 651-1495 Fax (732) 651-6757

*Name:	*City:
*State:	*E-mail:
*Daytime Phone:	*Date of Birth:

Please indicate:
Married: Yes No

Life Partner: Yes No

If married, and your spouse/life partner is eligible and applying at this time, please enter his/her name:

Your spouse/life partnerwill need to complete a separate form like this one, in order for us to prepare a joint quote (for which discounts may apply).

Smoker:
Yes No

Currently taking prescribed medications?

Medicine Name:	Dosage (How many/much per day):
Medicine Name:	Dosage (How many/much per day):
Medicine Name:	Dosage (How many/much per day):

Budget for Long Term Care Insurance
$ per person per month

O.K. now that the hard part is completed and you are still interested in finding out more information, lets begin to design a plan to fit your needs.

Daily Benefit:
Select a daily benefit, from $40 a day to $400 per day, in $10 increments.
FYI: Reviewing the FAQ page will help determine your daily benefit.

$ per day benefit

Home and Community Care:
Paid up to your choice of 50%, 80% or 100% of your selected daily benefit

percent of my daily benefit

Note: Assisted Living Facilities are usually covered at the Daily Benefit Amount. However, some companies will only pay at the Home and Community Care amount. Very important when comparing premium and benefits.

Benefit Period:
Select the length of time that benefits are payable.

Note: There are sometimes limitations for individuals age 82 and over. Most companies limit the benefit period to Two and Three years.

Two Years ( 730 days)

Three Years (1,095 days)

Four Years (1,460 days)

Five Years (1,825 days)

Unlimited

Elimination Period:
Decide when, after meeting the benefit-eligibility criteria, you want to start receiving benefits. The longer the elimination period the lower the premium.

0 days

7 days

30 days

60 days

90 days

Inflation Protection (optional):
This optional feature will increase the value of your daily benefit amount as well as your lifetime maximum benefit. You have your choice of either 5% simple or 5% compounding. The increase will occur on each anniversary of your policy, and will continue as long as your policy remains in force.

Notes:
· If you choose the simple benefit increase, your daily benefit and lifetime maximum benefit amount will increase each year at a rate of 5% of your original daily benefit and lifetime maximum benefit amount.

· If you choose the compounding benefit increase, your daily benefit and lifetime maximum benefit amount will increase each year at a rate of 5% of the previous year's daily benefit and lifetime maximum benefit amount.

5% Simple

5% Compounding

Thank you for completing this information.

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