Online Application Consent

The Federal Long Term Care Insurance Program (FLTCIP) online application process takes place over the internet using electronic records and signatures. During this process, you will be required to download important documents, enter personal data, and, at certain points, sign with an electronic signature. You will need a device with access to the internet in addition to Adobe software as described below. We recommend that you print (or store locally on your personal device) copies of all documents presented to you throughout the process.

Technical requirements

  • In order to effectively complete the online application process and access/retain electronic records, you will need an account with an internet service provider and a JavaScript-enabled internet browser running on a personal device. You must also have memory capable of electronically saving files on a storage device or a printer that will print out information displayed on your internet browser.
  • We employ secure technologies to safeguard the transmission of your personal information through this site. This encryption scrambles your information as it travels over the internet from your browser to our secure web server. It is supported in the newest versions of the most common internet browsers: Google Chrome, Firefox, Microsoft Edge, and Safari.
  • We have provided important application kit materials in connection with your application. You must read this information before you apply for coverage under the FLTCIP. The materials will be delivered in Adobe Acrobat Portable Document Format (PDF). To view, download, save, or print in this format, you must have or install Adobe Acrobat Reader on your device. If you do not have Adobe Acrobat Reader installed on your device, you can download it for free from the Adobe website.

Electronic signatures
At certain points during the application process you will be required to provide your electronic signature. To do this, you will select a checkbox indicating that you provide your authorization and it will include a date and time stamp. You will not be able to proceed with your application until you provide your signature. These signatures are passed to and stored in our database and then populated into a copy of your application that we will print and mail to you.

Getting paper copies
After you complete the online application process, you will be asked to review your application and sign it with an electronic signature. We will automatically send a paper copy of your application to you for your records. You can also request a copy of your application at any time using our secure email form, which you can access from your account dashboard. We strongly recommend that you print and maintain copies of any other materials provided to you in connection with your application.

To continue with this online application process, you must provide your consent. You also have the option to download or request a paper application. If you do not wish to submit your application online, click the "x" in the upper-right-hand corner of the screen to close the internet browser and call 1-800-LTC-FEDS (1-800-582-3337) TTY 1-800-843-3557 for assistance with the paper application process.

By checking the online application consent checkbox on the previous screen, I confirm that I wish to proceed with the online application process. I was provided access to Adobe Acrobat Reader and will download and read the application kit materials before completing this application. I consent to accept such information in the electronic formats provided except as I may otherwise specifically request.