Group Enrollment Long Term Care Insurance Preliminary Health Screen |
Please complete all sections, then select Submit at the bottom of the final page to send back to us.
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Long-term care insurance is medically underwritten - meaning that in order to make the best recommendations, gathering some basic health information is required to ensure insurability.
This health information will ONLY be used for the purpose of investigating LTC Insurance and will not be shared with anyone. After we have reviewed your answers, we will delete your response. if you are looking at LTC Insurance with a partner or spouse, they will need to complete a separate survey.
This health information will ONLY be used for the purpose of investigating LTC Insurance and will not be shared with anyone. After we have reviewed your answers, we will delete your response. if you are looking at LTC Insurance with a partner or spouse, they will need to complete a separate survey.
Please plan on 5 to 15 minutes to complete this survey.
Simply close your browser if you want to stop and not submit your questionnaire