Billing Change Form Description

Use this form to change your billing option for your coverage under The Federal Long Term Care Insurance Program (FLTCIP) and/or to consolidate your direct billing with another enrollee or have your premiums deducted from another employee or annuitant's pay. When completed, please return this form to:

Long Term Care Partners, LLC
PO Box 797
Greenland, NH 03840-0797

Close this window