$ $ What other benefits does the policy cover? 23. Is there a waiver of premium benefit? (Refer to page 23) If yes, • How long do you have to be in a nursing home before it begins? • Does the waiver when you receive home care? 24. Does the policy have a nonforfeiture benefit? If yes, what kind? (Refer to page 23) 25. Does the policy have a return of premium benefit? to page 24) 26. Does the policy have a death benefit? If yes, are there any restrictions before the benefit is paid? (Refer to page 23) 27. Will the policy cover one person or two? Tax-qualified status 28. Is the policy tax-qualified? (Refer to page 13) Partnership Policy 29. Is the policy tax-qualified? (Refer to page 11 ) What does the policy cost? (Refer to page 11) 30. What is the premium for the basic coverage? • each • each year 31. What is the premium if the policy covers home health care? • each month • each year 32. What is the premium if the policy covers an assisted living facility? • each month • each year 33. What is the premium if the policy has inflation coverage? • each • each year 34. What is the premium if the policy has a nonforfeiture benefit? • each month • each year Policy 1 Policy 2 yes/no yes/no yes/no yes/no yes/no yes/no yes/no yes/no yes/no yes/no one/two one/two yes/no yes/no yes/no yes/no $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
$ $ 35. Is there a discount if you and your spouse both buy policies? If yes, • How much is the discount? • Do you lose the discount when one spouse dies? 36. What is the total premium including all riders and discounts? • monthly premium • total annual premium 37. Can the premium increase in the future? Under what circumstances? 38. When you look at the results of Questions 29 through 36, how much do you think you’re willing to pay in premiums? Policy 1 Policy 2 yes/no yes/no $ $ yes/no yes/no $ $ $ $ yes/no yes/no $ $
10. Will the paying long-term care benefits decrease the policy’s death benefit and cash value? 11. Will an outstanding loan affect the long-term care benefits? 12. Did you get an illustration of guaranteed values? If yes, do the policy values equal zero at some age on a guaranteed or midpoint basis? If so, at what age? yes/no yes/no yes/no yes/no yes/no yes/no
West Virginia Dept. of Insurance P.O. Box 50540 Charleston, WV 25305-0540 (304) 558-3354 1-888-879-9842 Fax: (304) 558-0412 www.wvinsurance.gov West Virginia State Health Insurance Assistance Program 1-877-987-4463 (304) 558-3317 Fax: (304) 558-0004 West Virginia Bureau of Senior Services 1900 Kanawha Blvd, East Charleston, WV (304) 558-3317 877-987-3646 Fax: (304) 558-5609 Office of the Commissioner of Ins. State of Wisconsin P.O. Box 7873 125 Webster Street Madison, WI 53703-3474 (608) 266-3585 Fax: (608) 266-9935 Wisconsin SHIP (608) 266-1865 800-242-1060 Fax: (608) 267-3203 TTY: 888-701-1251 Wisconsin Bureau of & LTC Resources Dept. of Health and Family Services 1402 Pankratz St., Ste. 111 Madison, WI 800-815-0015 Fax: 608-246-7001 Wyoming Department of Insurance 106 East 6th Avenue Cheyenne, WY (307) 777-7401 Fax: (307) 777-2446 Wyoming Health Insurance Information Program 1-800-856-4398 Fax: (307) 777-2446 Wyoming Aging Division Department of Health 6101 Yellowstone Road, Room 259B Cheyenne, WY 82002 (307) 777-7986 or 1-800-442-2766 Fax: (307) 777-5340