Long-Term Care Insurance Policy Sample Contracts

Policy Form No. 21157 (0112) Nursing Facility and Residential Care Facility Only Insurance Policy
Long-Term Care Insurance Policy • May 2nd, 2014

FEDERAL TAX-QUALIFIED COVERAGE: THIS CONTRACT FOR LONG-TERM CARE INSURANCE IS INTENDED TO BE A FEDERALLY QUALIFIED LONG-TERM CARE INSURANCE CONTRACT AND MAY QUALIFY YOU FOR FEDERAL AND STATE TAX BENEFITS. THE BENEFITS PAYABLE BY THIS POLICY QUALIFY FOR MEDI-CAL ASSET PROTECTION UNDER THE CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE. ELIGIBIILTY FOR MEDI-CAL IS NOT AUTOMATIC. IF AND WHEN YOU NEED MEDI-CAL, YOU MUST APPLY AND MEET THE ASSET STANDARDS IN EFFECT AT THAT TIME. UPON BECOMING A MEDI-CAL BENEFICIARY, YOU WILL BE ELIGIBLE FOR ALL MEDICALLY NECESSARY BENEFITS MEDI-CAL PROVIDES AT THAT TIME, BUT YOU MAY NEED TO APPLY A PORTION OF YOUR INCOME TOWARD THE COST OF YOUR CARE. MEDI-CAL SERVICES MAY BE DIFFERENT THAN THE SERVICES RECEIVED UNDER THE PRIVATE INSURANCE.

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THIS IS A QUALIFIED CONTRACT. This contract for long-term care insurance is intended to be a federally qualified long-term care insurance contract and may qualify you for federal and state tax benefits.
Long-Term Care Insurance Policy • May 31st, 2021

This policy is intended to be a tax qualified long-term care insurance contract under Section 7702B(b) of the Internal Revenue Code of 1986, as amended.

FEDERAL TAX-QUALIFIED COVERAGE: THIS CONTRACT FOR LONG-TERM CARE INSURANCE IS INTENDED TO BE A FEDERALLY QUALIFIED LONG-TERM CARE INSURANCE CONTRACT AND MAY QUALIFY YOU FOR FEDERAL AND STATE TAX BENEFITS.
Long-Term Care Insurance Policy • September 30th, 2013

THIS POLICY IS AN APPROVED LONG-TERM CARE INSURANCE POLICY UNDER CALIFORNIA LAW AND REGULATIONS. HOWEVER, THE BENEFITS PAYABLE BY THIS POLICY WILL NOT QUALIFY FOR MEDI-CAL ASSET PROTECTION UNDER THE CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE.

ASSISTED LIVING PLUSSM
Long Term Care Insurance Policy • January 3rd, 2002

This contract for Long Term Care Insurance is not intended to be a federally-qualified Long Term Care Insurance contract. This policy is not a tax-qualified policy specifically because it offers benefit triggers (Conditions of Eligibility) that are more flexible than those permitted in a tax-qualified policy. This means it will generally be easier to qualify for benefits under this Policy than under a tax- qualified policy. As a result, this Policy may pay benefits in situations the tax-qualified policy will not.

ASSISTED LIVING PLUSSM
Long Term Care Insurance Policy • August 29th, 2002

This contract for Long-Term Care Insurance is not intended to be a federally-qualified Long Term Care Insurance contract. This Long Term Care Insurance Policy does not qualify You for the favorable tax treatment provided for the Internal Revenue Code of 1986, § 7702B. This Policy is not a tax-qualified policy specifically because it offers benefit triggers (Eligibility for Benefits) that are more flexible than those permitted in a tax-qualified policy. This means it will generally be easier to qualify for benefits under this Policy than under a tax-qualified policy. As a result, this Policy may pay benefits in situations the tax-qualified policy will not.

FEDERAL TAX-QUALIFIED COVERAGE: THIS CONTRACT FOR LONG-TERM CARE INSURANCE IS INTENDED TO BE A FEDERALLY QUALIFIED LONG-TERM CARE INSURANCE CONTRACT AND MAY QUALIFY YOU FOR FEDERAL AND STATE TAX BENEFITS.
Long-Term Care Insurance Policy • April 28th, 2014

THIS POLICY IS AN APPROVED LONG-TERM CARE INSURANCE POLICY UNDER CALIFORNIA LAW AND REGULATIONS. HOWEVER, THE BENEFITS PAYABLE BY THIS POLICY WILL NOT QUALIFY FOR MEDI-CAL ASSET PROTECTION UNDER THE CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE.

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