Your next step in exploring Long-term Care Insurance is completing this secure online health questionnaire, which typically takes 7-15 minutes.

Long-term care insurance involves medical underwriting. That means your health history influences the available solutions as well as the premium for which you may qualify.

Important notes:
- Completing this questionnaire is voluntary. Call us if you prefer to share this over the phone.
- This is not an application; it is a pre-application step.
- This information is not shared with third parties. It is used only by us for the purposes of helping us gauge your eligibility for insurance.
- Have your medication information handy. It will help you complete the questionnaire faster.
- If a spouse or partner is interested in coverage, they need to complete their own questionnaire.
If you stop and want to return to finish this questionnaire, your information is NOT saved, and you will need to start again.

This Questionnaire is HIPAA compliant.
LTCI Partner's Privacy Policy

Questions?
855-204-1214
mpg@ltcipartners.com
 
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