Applications for the Federal Long Term Care Insurance Program

Only certain groups are eligible to apply for coverage under the Federal Long Term Care Insurance Program (FLTCIP). To first determine if you are eligible to apply, go to the Who's Eligible section of this website.

Please read the materials in the Information Kit before you apply for coverage under the FLTCIP. If you have already read these materials, download an application or apply online below. You will need to determine which application you can use.
 

		Full Underwriting Application
		Supplemental Answers for Application
		Abbreviated Underwriting Application
		Supplemental Answers for Abbreviated Application
		Coverage Change Application
		Supplemental Answers for Application
		Apply Online (Abbreviated Underwriting Only!)

In order to read either application, you need the free Adobe Acrobat Reader.