Section 13, Part B.1 - Long Term Care Insurance - Detailed Questions - FOR NEW HOUSEHOLDS ONLYSection 13, Part B.1 collects detailed information about long term care insurance policies reported in Part A.2.
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What is the name of the insurance company for "your (1st, 2nd, 3rd)"
long term care policy? [enter text] __________________
Briefly describe the policy. [enter text] ______________
Are the policy premiums paid -
Are any premiums paid through payroll deductions?
Since the first of the reference month, what was your or your household total expense for this insurance policy? [enter value] ______________
* Enter the actual amount the household paid. Do not include any expenses paid for the household by others
How much was paid this month? [enter value] ______________
* Enter 'C' for a combined expense
What other type of policy is the "long term care insurance" combined with?
Which property (ies) does this policy cover? [enter text] ______________
Do you or any members of your household have any or make payments for any other "long term care insurance" policy?
End of Section 13B Long Term Care Insurance
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Last Modified Date: April 7,2016