Quotes

  • Long Term Care Insurance
  • Universal Life Insurance with LTC Benefits
  • Fixed Annuity with LTC Benefits

We recommend you first read QuickQuote which will give you an idea of the cost of financing long term care before filling out this form. We also recommend you read the Guide to understand the terminology and plan choices.

To receive a personalized quote just complete this short form and we will email you the lowest rates from top insurance companies. Quotes based on current rates from the top companies as of

We represent all the major insurance carriers for long term care insurance, life insurance and annuties with LTC riders. The premiums are the same if you buy your insurance through us, another agent or agency, or directly from a company or organization.

An advisor will contact you to make sure you received the information and to answer questions you may have. We can also arrange for a local advisor meet with you.

Fill out this form only if you are interested in insuring through us in the next 60 days because the rates, your age, or your health can change (it happens all the time) and the quote will no longer be accurate. Bookmark us to return later.

The more information you provide in the form the more accurate quote we can provide.

We respect your privacy, we do not share this information.


Name or Initials:
Age
Spouse/Other Name or Initials:
Age
Status
Single
Married*
Partner*
Sibling*
* may qualify for LTC insurance discount: spouses, 2 people share living expenses (partners, siblings), 2 applying-2 approved, 2 applying-1 approved, 1 applying
Does either applicant take prescription medications?
Y N
*specify what meds taken, what for, and which applicant
Does either applicant use tobacco?
Self Other Applicant

The reason I am requesting a quote.
Preference for being contacted. (required)

I have already read the QuickQuote and the premium is affordable.
Y N
I have already read the LTC Guide.
Y N

I currently have a long term care insurance policy:
Y N
I want to apply by: (required)
by Mail/FedEx In-Person
Also send information on small business and corporate plans.
Y N
When do you want to start?

I am interested in : A, B, or C -- (see guide for comparisons)
A: Long Term Care Insurance Quote
How much have you budgeted for a monthly premium?
per person
How much of a daily benefit do you want to receive?
blankHow long do you want the benefits for?

B: Universal Life Insurance with LTC Benefits Quote
I currently have: (select sources of funding if any)
Whole Life or Universal Life policy (not Term Life) Current policy cash $
Other sources for Life/LTC funding (investment/cash) $
Life/LTC policy amount desired: (limit depends on company)

C: Fixed Annuity with LTC Benefits Quote

Annuity LTC rider desired amount :
 (limit depends on company)
Non-Qualified: after-tax dollars. Taxes have been paid.
Usually stocks, bonds, savings, CD's, money market accounts.
Can transfer to annuity with LTC.
Annuity CD Money Market Savings Other $

Qualified: employer provided plan or an individual retirement plan.
Usually 401ks, IRAs, retirement plans, tax deferred annuities.
Consult with plan about any possible early withdraw penalty.
401k IRA Other $

City and State of residence:
(required - quotes are state specific)
E-mail me the quote to :
(required to send quote)
 (email address)
Phone: (entry required)
*an advisor will explain the quote and answer any questions
Best days to contact you:
M-F Sat Sun
Best times to contact you:
 AM — PM

How did you find this website?
Are you an agent or licensed to sell insurance (active or inactive)? (required)


Call toll free 1-888-582-2464 or Email Us
if you have any questions.
 


1. requires health underwriting.
2. requires health underwriting
3. no underwriting (good if declined or uninsurable for life insurance or LTC insurance.)