Individual/Couple Long Term Care Individual/Couple Long Term Care InformationIs this for an Individual or Couple? Individual Couple Daily Benefit: Show as monthly benefit Yes No Home Care %:50%75%100%150%Benefit Period:1 year2 years3 years4 years5 years6 yearsElimination Period:0 days60 days90 days180 days365 daysOtherInflation:Guaranteed Purchase Option (GPO)5% simple3% compoundCPI5% compoundHHC Policy Type:ReimbursementIndemnity (requires service days)CashAdditional Comments: (ie. travel, hazardous activities, replacement of coverage, etc)Riders: Zero day E.P homecare Nonforfeiture Shared Care Survivorship Restoration of Benefits Return of Premium Does your client have problems with memory or other cognitive impairment? If so, please provide details:Notes:What would you like to do next?* Submit, I'm finished Submit, and do another for same client Submit, and do another for a different client CommentsThis field is for validation purposes and should be left unchanged. Δ
