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Long Term Care :

Long-term care (LTC) is the assistance that is provided to people who are unable to perform the Activities of Daily Living (ADLs) that healthy, fully-functional people do independently and on a daily basis. The need for long-term care services arises from chronic health conditions and/or physical disabilities - such as a stroke, Multiple Sclerosis, Parkinson's or Alzheimer's disease.

Long term care is provided over a long period of time at home, in an assisted living facility or at a nursing home. Levels of care are specifically defined as:
  • Skilled care, required around the clock, is provided by licensed medical professionals under the direct orders of a physician;
  • Intermediate care is skilled care required occasionally; and
  • Custodial care, for people who need assistance with Activities of Daily Living (ADLs) - bathing, continence, dressing, transferring, toileting and eating

As we live longer, the likelihood of needing long term care increases. Based on a Harvard University study, one in five Americans over age 50 are at high risk of needing long-term care services during the next 12 months. In fact, the need can occur at any age.

A long-term illness can deplete a lifetime of accumulated assets very quickly. One year of nursing home expenses averages $40,000 - $80,000 nationally. The average length of care is 2 1/2 years for 80% of individuals requiring long term care. The other 20% require more than 5 years. Health insurance usually won't cover all of these costs, and Medicare has restrictions and limitations on long-term care benefits.

Long-term care insurance is the only insurance designed to help cover the costs of long-term care services. Without it, chances are good you'll be responsible for paying most, if not all, of the costs out of your own pocket. Long-term care services simply aren't fully covered by any other type of insurance.
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Even the best medical, HMO or PPO plan won't adequately cover it because their focus is "acute" health care.
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Disability income insurance is generally about replacing lost income and provides no long-term care insurance benefits.
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Medicare covers some care in Nursing Homes and at Home, it does so only for a limited time subject to restrictions.
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What Medicare doesn't pay, your Medicare Supplement won't pay either.
It's usually less expensive if you buy long-term care insurance when you're younger. In fact, with most plans, the longer you wait the more it will cost you - for the exact same coverage. That's why it's such a good idea to consider long-term care insurance as an integral part of a well-rounded financial plan. It may help protect your hard-earned assets, and provide more control over how and where you receive care should you need it. With a wide range of benefits, you can help ensure that you will be able to get the type of care you need, where you want it

Please ensure you complete the quotation form below as accurately as possible. If you would rather speak to one of our representatives, Please Call (732) 521-3040 or e-mail: info@horizoncoast.com to setup a confidential consultation.

Completion of this form is for informational purposes only, and is just an estimate and is not a statement of contract. Coverage may not apply in all states. This WILL NOT result in a new policy, or change to an existing policy. For complete details of coverage, conditions, limits and losses not covered, be sure to read the policy, including all endorsements
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   General Information
Name:
Address:
City:
  State:   Zip:
Day Phone:
       Night Phone:
Email Address:
Soc. Sec. #:
Date of Birth (mm/dd/yy): 
Age:
Sex:
Height:
ft./in.      
Weight: lbs.
Marital Status: 
Married     Single
 
If married, will spouse also apply for coverage?
Y N
NOTE: If "YES", your spouse will need to complete a seperate form.
   Current/Previous Insurance Information
Do you currently have another Long-Term Care insurance policy, rider or certificate (including health care service contract or health maintenance organization contract)? Y
N
Did you previously have another Long-Term Care insurance policy, rider or certificate in force during the last 12 months? If so, when did it lapse

(mm/dd/yy):
Y
N
Are you covered by a state assistance program (Medicaid)? Y
N
Do you intend to replace any of your medical or health insurance coverage with this policy, rider or certificate? Y
N
Are you now receiving long-term care or disability benefits? Y
N
Have you ever been denied coverage for medical insurance, disability insurance, long-term care insurance, nursing home insurance, or life insurance? Y
N
If "Yes", please explain below:
   Activities Information
Have you been confined to a hospital in the last 12 months? Y
N
Has a physician recommended in the past 24 months that you be hospitalized or confined to a nursing facility, or that you have a surgical procedure? Y
N
Have you consulted with a physician in the last 12 months for loss of appetite, falling, unstable gait, bladder or bowel control, dizziness or vision problems, or weight loss of 10 pounds or more? Y
N
Do you intend to replace any of your medical or health insurance coverage with this policy, rider or certificate? Y
N
Do you need the help or supervision of another individual to perform your everyday living activities such as walking, dressing, eating, taking medications or tending to personal hygiene? Y
N
Do you need the help or supervision of another individual to perform the independent activities of daily living such as handling your finances, doing laundry, shopping or using the telephone? Y
N
Do you use any assistive devices such as a walker, wheelchair, crutches, cane, grab bars or any prescribed medical device or appliance? Y
N
If "Yes", please explain below:
 
   Medical Information
If you answer "Yes" to any of the questions below, please use the text box at the end of this section to explain your answer.
In the past 5 years have you ever had, been told by a physician you had, or been treated for:
osteoarthritis, osteoporosis, amputation, bone or joint disease, rheumatoid arthritis, or spinal stenosis? Y N
Internal cancer, tumor, leukemia, lymphoma, or Hodgkin's disease? Y N
Disease of the kidney, stomach, liver, pancreas, or small or large intestine; or cirrhosis? Y N
diabetes or thyroid disease Y N
Disease of the lungs or respiratory system, emphysema, asthma, or shortness of breath? Y N
Disease of the heart or circulatory system, heart attack, high blood pressure or angina? Y N
Psychological, psychiatric or mental disorders, anxiety or depression? Y N
neurological disorders including Parkinson's disease, multiple sclerosis, Alzheimer's disease, stroke/TIA, paralysis, convulsions, epilepsy, seizures or muscular dystrophy? Y N
Have you been treated or diagnosed by a member of the medical profession as having Acquired Immune Deficiency Syndrome (AIDS) or have you tested positive for the HIV virus (as indicated by the results of the ELISA-ELISA Western blot test series)? Y N
Have you received medical advice, treatment or counseling relating to alcohol or drug abuse? Y N
If you replied Yes to any question in this section, please explain your answer(s):
  Medical Information
Please list below any prescription medications that you are currently taking:
Additional Information
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Do you have a valid driver's license and drive at least twice per week?
Are you employed outside of the home or do you participate in any volunteer activities or organizations at least 8 hours per week? Y
N
Have you used tobacco products within the past 12 months?
Please give any additional comments you feel appropriate for this quotation
 
 
     

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