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All quotes and final rates are set by the respective long term care insurer. We do not set quotes or rates. No long term care insurance agent/broker/producer can alter or negotiate what the insurer will charge if coverage is issued.
All quotes are based on particular risk categories. Your personal classification will determine what the actual final premium rate offer from the insurer is, after your application is processed (underwritten).
If you see apparently different quotes for the same product for the same insurer, that does not mean that one producer can get you a different price than another. It just means that different factors were used in generating the quote. The actual rate that you as an individual may be offered by any particular insurer may differ substantially from quotes you receive, especially if the original quotes are too optimistic regarding your personal risk classification.
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The more complete and accurate the information, the more realistic the quote can be.
*Required entries
*Name: *State:
Telephone *Day: *Evening:
*Birthdate: * Height: *Weight (lbs):
*Male Female *Prior decline for long term care insurance? Yes No
Cause of decline:
Insurer:
*Ever received worker's comp. or disability pay? Yes No When?
Reason for payment:
Type:
% paid:
Benefit period preferred Max. monthly cost you'd consider
*Tobacco use - type, amount, date of last use / never:
Last 5 years medical conditions, treatment, dates, current status (mental, physical):
Please read this list of medical conditions for specific details needed.
Surgery, hospitalization, therapy last 5 yrs - start-finish/current, release by doctor?:
Surgeries, tests, procedures recommended but not performed - what & when:
Physical impairments:
Medications prescribed in last year- reason, dosage, how long taken, first diagnosis:
Date last seen by a physician - reason and result:
Readings & date — Blood pressure: Cholesterol:
Been resident in a nursing home or used home health care - when, why, how long?
Alcohol or substance abuse:
List all aids used e.g., cane, brace, walker, hospital bed, oxygen, dialysis, crutches:
All help needed e.g., shopping, housekeeping, bathing, toileting, handling finances:
Memory loss, or confusion? Yes No Discussed with physician? Yes No
Additional comments:
*Your e-mail address:
*Repeat e-mail address:
The actual coverage and rate offer to a particular applicant is made by the insurer after review and underwriting of the application.