« Back to Home Page

My Long-Term Care Insurance Quote Worksheet

Insurance Company 1
Insurance Company Name:
Company Phone Number:
Company Address:
Contact:
What is the daily benefit?:
What is the benefit period?:
What is the elimination period?:
What is the inflation rider?:
What is the home-health-care clause?:
Qualifications of benefits: Medical Necessity
Impairment In ADL
Cognitive Impairment
Cost of yearly premium?:
How long selling LTC?:
How much LTC do you have in force?:
How many times has the rate increased for those who already own a policy?
 
In how many states are you currently selling LTC?
 
Is your company on the block to be sold?
  Yes    No
How are you rated?:



Insurance Company 2
Insurance Company Name:
Company Phone Number:
Company Address:
Contact:
What is the daily benefit?:
What is the benefit period?:
What is the elimination period?:
What is the inflation rider?:
What is the home-health-care clause?:
Qualifications of benefits:
Cost of yearly premium?:
How long selling LTC?:
How much LTC do you have in force?:
How many times has the rate increased for those who already own a policy?
 
In how many states are you currently selling LTC?
 
Is your company on the block to be sold?
  Yes    No
How are you rated?:



Insurance Company 3
Insurance Company Name:
Company Phone Number:
Company Address:
Contact:
What is the daily benefit?:
What is the benefit period?:
What is the elimination period?:
What is the inflation rider?:
What is the home-health-care clause?:
Qualifications of benefits:
Cost of yearly premium?:
How long selling LTC?:
How much LTC do you have in force?:
How many times has the rate increased for those who already own a policy?
 
In how many states are you currently selling LTC?
 
Is your company on the block to be sold?
  Yes    No
How are you rated?:



Insurance Company 4
Insurance Company Name:
Company Phone Number:
Company Address:
Contact:
What is the daily benefit?:
What is the benefit period?:
What is the elimination period?:
What is the inflation rider?:
What is the home-health-care clause?:
Qualifications of benefits:
Cost of yearly premium?:
How long selling LTC?:
How much LTC do you have in force?:
How many times has the rate increased for those who already own a policy?
 
In how many states are you currently selling LTC?
 
Is your company on the block to be sold?
  Yes    No
How are you rated?: