Information and Forms
All documents are in Adobe Reader PDF format unless otherwise noted. To open these materials, click on the appropriate version. For applications, go to the Apply section of this website.
| Information Kit Materials | Download |
|---|---|
| You can download each of the FLTCIP information kit materials independently or download the entire kit as a .zip file. You can also request a FLTCIP information kit and application by mail. | |
| Book One: Program Details and Rates [Description] |  (1.4 MB) |
| Book Two: Additional Information [Description] | (.8 MB) |
| NAIC: A Shopper's Guide to Long Term Care Insurance [Description] | (7 MB) |
| Full Underwriting Information Kit* [Description] |  (9 MB) |
| Abbreviated Underwriting Information Kit* [Description] | (9 MB) |
* Note: The entire information kits are saved as .zip files, also known as "compressed folders" on Microsoft Windows systems. If you are unsure which application you need (full underwriting or abbreviated underwriting), click here.
| Informational Brochures | Download |
|---|---|
| Program Overview Brochure [Description] | (.8 MB) |
| Choosing a Medigap Policy: Guide to Health Insurance for People with Medicare [Description] | (3 MB) |
| Forms and Worksheets | Download |
|---|---|
| Billing Change Form [Description] | (.5 MB) |
| Benefits and Features Comparison Worksheet [Description] | (.2 MB) |
| Authorization for Disclosure of Information—Compliance [Description] | (.1 MB) |
| Claims Forms | Download |
|---|---|
| Understanding the Claims Process Brochure | (1 MB) |
| Personalized Worksheet for Benefit Eligibility Interview | (.1 MB) |
| Release of Information Forms | (.1 MB) |
| Authorization for Disclosure of Information—Claims | (.6 MB) |
| Assignment of Benefits Form | (.1 MB) |
| How to Receive Payment for Services After Your Request for Benefits Is Approved | (.1 MB) |
| Informal Caregiver Invoice | (.1 MB) |