The Federal Long Term Care Insurance Program Send to printerSend to Printer Close this WindowClose


Applications IconFLTCIP 2.0 Applications for the Federal Long Term Care Insurance Program

Download an Application

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

  Adobe PDF version Full Underwriting Application
Adobe PDF version

Supplemental Answers for Full Underwriting Application




Adobe PDF version     Declaration of Domestic Partnership form


Adobe PDF version Abbreviated Underwriting Application
Adobe PDF version

Supplemental Answers for Abbreviated Underwriting Application



In order to download the applications/forms above, you need the free Adobe Acrobat Reader.




Call: 1-800-LTC-FEDS (1-800-582-3337) (TTY: 1-800-843-3557) Close this Window Close