3% of survey complete.
Health Questionnaire Information

Your next step in exploring Long-Term Care Insurance is completing this secure online health questionnaire. It typically takes about 5-15 minutes.

Long-term care insurance involves medical underwriting. That means your health history influences the available solutions.

We will assess your answers and inform your advisor of your potential eligible solutions.

Important Notes:

This is not an insurance application; it is a pre-application step.
- Have your medication information handy. It will help you complete the questionnaire faster.
- This questionnaire is HIPAA compliant. We do not share your information with third parties except it may be shared with your advisor as part of assisting you in this process.
- If a spouse/partner is interested in coverage, they need to complete their own questionnaire.

Please be as thorough as possible.

Call us at 877-949-4582 and ask for assistance with the Underwriting Partner Questionnaire.

Please use the PREVIOUS PAGE (PREV) button, not the BACK button on your browser.
If you stop and leave the questionnaire, your information is NOT submitted, and you will need to start again.