Information and Forms

All documents are in Adobe Acrobat PDF format unless otherwise noted. To open these materials, click on the appropriate version. For applications, go to the Apply section of this website.

Information Kit Materials	PDF
You can download each of the FLTCIP Information Kit materials independently or download the entire kit in WinZip format. You can also request a FLTCIP Information Kit and application by mail.
Book 1 - Program details and rates [Description]
Book 2 - Additional information [Description]
NAIC - A Shopper's Guide to Long Term Care Insurance [Description]
Full Underwriting Information Kit ( - Approx. 9MB)*
Abbreviated Underwriting Information Kit ( - Approx 9MB)*
* Note: The entire Information Kits are saved using WinZip Computing, Inc.'s WinZip for Windows. You can download a free evaluation copy of WinZip to open these files. If you are unsure which application you need (full underwriting or abbreviated underwriting), click here.

Informational Brochures	PDF
Program Overview Brochure
Choosing a Medigap Policy: Guide to Health Insurance for People with Medicare [Description]

Forms & Worksheets	PDF
Billing Change Form [Description]
Benefits and Features Comparison Worksheet [Description]
Authorization for Disclosure of Information [Description]

Claims Forms	PDF
Release of Information Forms
Assignment of Benefits Form
How To Receive Payment for Services After Your Request for Benefits Is Approved
Informal Caregiver Invoice