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• LTC Insurance
• Life/LTC
• Annuity/LTC
• Quick Quote
• Custom Quote

• Home
• LTC Insurance
• Life/LTC
• Annuity/LTC
• Quick Quote
• Custom Quote
• 
• 

custom quotes

Long Term Care Insurance
Life Insurance with LTC benefits
Annuity with LTC benefits

We recommend you first read Quick Quote – this will give you an idea of the cost of long term care insurance.

The 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.

We DO NOT share or sell your information. We are not a "lead" company. You will not be getting multiple phone calls from different agents.

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 90 days because the rates, your age, or your health can change (it happens all the time) and the quote will no longer be accurate.

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.

I am interested in : A, B, or C (you can select more than one) A: Long Term Care Insurance Quote How much have you budgeted for a monthly premium? Select One $100/month $200/month $300/month $400/month $500/month $600/month $700/month $800/month $900/month $1000/month per person How much of a daily benefit do you want to receive? Select One $100/day $150/day $200/day $250/day $300/day $350/day $400/day $450/day $500/day How long do you want the benefits for? Select One 1 year 2 years 3 years 4 years 5 years 6 years 7 years 10 years unlimited B: Life Insurance with LTC Benefits Quote I currently have: (select sources of funding if any) Current Whole Life or Universal Life policy (not Term life insurance) Current policy cash $ Other sources for Life/LTC funding (cash/qualified) $ Life/LTC policy amount desired: select one 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 500,000+ (limit depends on company) C: Annuity with LTC Benefits Quote Annuity LTC rider desired amount : select one 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 500,000 500,000+ 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 $ non-Qualified vs Qualified explained Qualified: employer provided plan or an individual retirement plan. Usually 401ks, IRAs, retirement plans, tax deferred annuities, age 59 1/2 or older. Consult with plan about any possible early withdraw penalty. 401k IRA Other $

Name or initials: Age Weight: Lbs. Height: (ft, in) Spouse or Other: Age Weight: Lbs. Height: (ft, in) Marital Status (possible discount even if only 1 insures). Select One Married Partner-Sibling Single 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 is: Select One Curious about price. Price shopping Compare quotes Need insurance Ready to buy Uninsurable/Declined I have read the Quick Quote and the premium is affordable. Y N Do you currently have a long term care insurance policy? (required) Y N Are you an agent or licensed to sell insurance (active or inactive)? (required) Y N Are you working with anyone now about long term care insurance? (required) Y N I prefer to apply by: (required) Mail/FedEx In-Person When do you want to apply? (required) select one ASAP this month 1-3 months 3-6 months more than 6 months City and State of residence: (required) E-mail me the quote to : (required to send quote) (email address) Phone: (required) Best days to contact you: M-F Sat Sun Best times to contact you: AM — PM How did you find this website? select one Google Ad Radio or TV Newspaper or magazine Bay Area Reporter Advocate Web Search Relative, friend, co-worker Link on a website AARP website or article

Call toll free 1-888-582-2464 or email us if you have any questions.