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Daily Benefit

How much the policy pays out per day for nursing care or home health care is the Daily Benefit.

Benefit Period

The length of time for which a policy will continue to pay the benefits associated with long-term care is the Benefit Period.

Elimination Period

With most policies, your benefits won't start the first day you go to a nursing homeor start using home care. During an Elimination Period, the policy will not pay thecost of long-term care services.

Inflation Protection?

There is an option with most plans called an Auto Inflation Rider , available at an additional cost, which increases the benefits according to the rises in inflation. For Texas consumers, compound protection must be rejected before other forms are considered.

Nonforfeiture Benefits

No Yes

Nonforfeiture benefits in policies, available at an additional cost, provide that at least some benefits will be paid even if the buyer fails to keep up premium payments and the policy is cancelled for non-payment.

Preferred Payment Mpde

Annual Semi-Annual Quarterly Monthly

The Payment Mode indicats whether you want to pay for the insurance once a year (annually), semi-annually, quarterly or monthly. When not paying annually there is usually an additional administration fee.

Name:*

Last Name:*

Phone Number*

- Area Code Phone Number

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Birth Date*

Month Day Year

Gender*

Do you use tobacco products?*

E-mail Address*

Do you have any pre-existing medical conditions?*

Yes No

Do you currently take any medications?*

Yes No

Height*

Weight*

Long Term Care Options