Long term care quote

Long Term Care Insurance Specialist/Broker

Quote

Sandy Silverman

Long Term Care Leader

Independent
Insurance Agency

Past President of
Industry Organizations

Future Cost!

Long Term Care Costs!

2013 - $90,597

2023 - $147,571

2033 - $240,374

In order for Sandy Silverman to respond promptly and accurately to your request for pricing information and policy recommendations, the Long Term Care Pre-qualifying Inquiry Form must be completed and submitted.

The recommendations you receive from us will depend upon the client's age and health history.

Instructions:

Complete one form for each applicant (even if husband and wife are both applying).
Fill in all information.
After recording age and spouse information, ask your client the following 3 questions:

1. Have you been hospitalized during the last 5 years? If so, why?
2. Are you taking any medications? If so, what are you taking?
3. What else do I need to know about your health?

Privacy Policy
Information that is submitted to our company will remain confidential. We believe you have the right to complete and total privacy. For that reason, we promise never to share or resell your unless appropriate for the provision of Long Term Care Insurance.

Please note: All items are required fields.

Long Term Care Pre-qualifying Inquiry\Quote Request

Name:

Date of Birth:

Today's Date:

Address:

City:

State:

Zip:

Telephone:

Email:

Is your spouse also applying?
(If yes, please complete separate form)

No Yes

Your height:

Your weight:

Do you have symptoms of, or within the last 7 years, have you received medical advice, diagnosis or treatment or consulted with a member of the medical profession for any of the following conditions:

Details:

Questions#	Date of Onset	Details
Questions#	Date of Onset	Details
Questions#	Date of Onset	Details

Medications:

Have you been hospitalized in the last 5 years?

Date:		Details:
Date:		Details:

If you have any questions, call Sandy at (941) 355-2273. We are here to serve you and your clients!

Are You At Risk?

Risk Comparison

1 in 1200
The chance of a $100,000 loss from a fire or accident in your home

1 in 240
The probability of a $100,000 or greater liability suit arising from an automobile accident

1 in 15
The chance you will encounter major medical health care expenses of $ 100,000 or more

1 in 4
The chance that you will have a major long term care expense

What STEPS Have
You Taken?

Why Buy?

Independence
Family Protection
Choices
Protect Savings
Protect Assets
Peace of mind
Favorable
Tax Treatment