Houston, Texas insurance

Group Long-Term Care (LTC) Insurance

Group Long-Term Care Insurance Long-Term Care is the type of care received either at home or in a facility, when someone needs assistance with activities of daily living, such as bathing and dressing due to an accident, an illness or advancing age.

Rising life expectancy means that the potential need for "long-term care" grows with every passing year of your life. The likelihood is that you or a member of your family will need long-term assistance due to a prolonged illness, a disability, or general deterioration of your health and ability to perform routine daily activities. Most long term care expenses are not covered by Social Security or Medicare, Medicare Supplement ("Medigap"), or private health insurance. Medicaid pays for nearly half of all nursing home care, but you must meet federal poverty guidelines and may have to "spend down" most of your assets on health care.

Group Long-Term Care Insurance Quote Request

Please take a moment to fill out the form below and one of our local insurance agents will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.

* Required fields.

General Information
Legal Name of Business:
Contact Name: *
Address:
City:
State:     Zip:
Business Phone: *  
Best Time To Call:   AM   PM
E-mail Address: *

Business Information
Type of Business:
Number of Employees to be Insured:
Do you currently offer long-term care insurance to employees? Yes   No
Want long-term care insurance coverage for:
Give a complete description of any type of hazardous/dangerous duties performed by your employees:

Current Group LTC Insurance Information
Carrier (Company) Name (not agency):
Policy Expiration Date:   Premium Amt: $
Years Insured:
Please give a brief description of your current Group LTC plan:

Coverage Options
Type of Coverage: New Coverage
Additional Coverage
Replacement
Waiting Period:
Daily Benefit Amount:
Benefit Period:
Inflation Protection:
Do you want your policy to include home-health care coverage? Yes   No

Employee Information
Please list all employees you wish to cover:
Employee Name Date of Birth Salary Sex Dependent Status
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
If you were not able to list all employees you wish to cover in the spaces above, please use the Additional Comments section below or indicate that you will fax or e-mail an additional listing.


Additional Comments or Questions

security code Enter Security Code:


Please click the "Submit Quote Request" button to send your quote request. No coverage is in effect until bound by an insurance carrier. This is a request for quotation only.



Share/Bookmark