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Download an Application

Please read the materials in the FLTCIP Information Kit before you apply for coverage under the Federal Long Term Care Insurance Program (FLTCIP). If you have already read these materials, you need to determine which application you can use. You can download that application below.

Full Underwriting Application

		FLTCIP 2.0 Full Underwriting Application
		Supplemental Answers for Full Underwriting Application
		Declaration of Domestic Partnership form

Abbreviated Underwriting Application

This application is only for new/newly eligible employees and their spouses or newly married spouses of employees applying within 60 days of becoming eligible.

		FLTCIP 2.0 Abbreviated Underwriting Application
		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)

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