<html> <head> <title>Rule 20:06:21:0F Disclosure Form.</title> <META NAME="Keywords" Content="Administrative Rules 20:06:21:0F"> <META NAME="Description" Content="Administrative Rules 20:06:21:0F Disclosure Form."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 14 (filtered)"> <title>DEPARTMENT OF REVENUE AND REGULATION</title> <style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:12.0pt; font-family:"Times New Roman","serif";} h6 {margin:0in; margin-bottom:.0001pt; text-align:justify; page-break-after:avoid; font-size:12.0pt; font-family:"Times New Roman","serif";} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>DEPARTMENT OF LABOR AND REGULATION</span></font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>DIVISION OF INSURANCE</span></font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>DISCLOSURE FORM</span></font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>THINGS YOU SHOULD KNOW BEFORE YOU BUY LONG-TERM CARE INSURANCE</span></font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>Chapter 20:06:21</span></font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>APPENDIX F</span></font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>SEE: &#167; 20:06:21:53.02</span></font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal align=center style='text-align:center'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size: 12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b><span style='font-weight:bold'>Source:</span></b> 28 SDR 157, effective May 19, 2002; 33 SDR 230, effective July 2, 2007.</font></p> <p class=MsoNormal><font size=3 face="Times New Roman">&nbsp;</font></p> <b><font size=3 face="Times New Roman"><span style='font-size:12.0pt; font-family:"Times New Roman","serif";font-weight:bold'><br clear=all style='page-break-before:always'> </span></font></b> <p class=MsoNormal align=center style='text-align:center'><b><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-weight:bold'>Things You Should Know Before You Buy</span></font></b></p> <p class=MsoNormal align=center style='text-align:center'><b><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-weight:bold'>Long-Term Care Insurance</span></font></b></p> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman">&nbsp;</font></p> <table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 style='border-collapse:collapse'> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><b><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-weight:bold'>Long-Term</span></font></b></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>" &nbsp;&nbsp;&nbsp;A long-term care insurance policy may pay most of the costs for your care in</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><b><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-weight:bold'>Care</span></font></b></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;a nursing home. Many policies also pay for care at home or other community</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><b><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-weight:bold'>Insurance</span></font></b></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;settings. Since policies can vary in coverage, you should read this policy and</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;make sure you understand what it covers before you buy it.</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>" &nbsp;&nbsp;&nbsp;[You&nbsp; should <b><span style='font-weight:bold'>not</span></b> buy this&nbsp; insurance policy unless you can afford&nbsp; to pay the </span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;premiums every year.] [Remember that the company can increase premiums</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;in the future.]</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>" &nbsp;&nbsp;&nbsp;The&nbsp; personal&nbsp; worksheet&nbsp; includes&nbsp; questions&nbsp; designed to help&nbsp; you&nbsp; and the</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;company determine whether this policy is suitable for your needs.</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><b><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-weight:bold'>Medicare</span></font></b></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>" &nbsp;&nbsp;&nbsp;Medicare does <b><span style='font-weight:bold'>not</span></b> pay for most long-term care.</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><b><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-weight:bold'>Medicaid</span></font></b></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>" &nbsp;&nbsp;&nbsp;Medicaid will generally pay for long-term care if you have very little income</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;and&nbsp; few&nbsp; assets. You&nbsp; probably&nbsp; should&nbsp; <b><span style='font-weight:bold'>not</span></b> buy this&nbsp; policy if &nbsp;you&nbsp; are now</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;eligible&nbsp; for Medicaid.</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>" &nbsp;&nbsp;&nbsp;Many&nbsp; people&nbsp; become eligible&nbsp; for&nbsp; Medicaid after&nbsp; they have&nbsp; used&nbsp; up their </span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;own financial resources by paying for long-term care services.</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>" &nbsp;&nbsp;&nbsp;When Medicaid pays your&nbsp; spouse's nursing&nbsp; home bills,&nbsp; you&nbsp; are allowed to</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;keep your&nbsp; house and furniture,&nbsp; a living allowance,&nbsp; and some&nbsp; of&nbsp; your joint </span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;assets.</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>" &nbsp;&nbsp;&nbsp;Your&nbsp; choice of long-term care&nbsp; services may be limited&nbsp; if you are receiving</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;Medicaid.&nbsp;&nbsp; To&nbsp; learn&nbsp; more&nbsp; about&nbsp; Medicaid,&nbsp;&nbsp; contact&nbsp; your&nbsp; local&nbsp; or&nbsp; state </span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;Medicaid agency.</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><b><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-weight:bold'>Shopper's</span></font></b></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>" &nbsp;&nbsp;&nbsp;Make sure the insurance company or agent gives you a copy of a book called</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><b><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-weight:bold'>Guide</span></font></b></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;the National Association of Insurance Commissioners' &quot;Shopper's Guide to</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;Long-Term Care Insurance.&quot; Read it carefully. If you have decided to apply</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;for long-term care insurance,&nbsp; you have the right to return&nbsp; the policy within </span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;30 days and get back any premium you have paid if you are dissatisfied for </span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;any reason or choose not to purchase the policy</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal><b><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-weight:bold'>Counseling</span></font></b></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>" &nbsp;&nbsp;&nbsp;Free counseling and additional information about&nbsp; long-term care&nbsp; insurance</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;are available&nbsp; through&nbsp; your state's&nbsp; insurance&nbsp; counseling&nbsp; program.&nbsp; Contact</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;your&nbsp; state&nbsp; insurance&nbsp; department or department on aging for more informa-</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;tion about the senior health insurance counseling program in your state.</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><b><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-weight:bold'>Facilities</span></font></b></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>" &nbsp;&nbsp;&nbsp;Some long-term care insurance contracts provide for benefit payments in</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;certain facilities only if they are licensed or certified, such as in assisted</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;living centers. However, not all states regulate these facilities in the same</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;way. Also, many people move to a different state from where they purchased </span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;their long-term care insurance policy. Read the policy carefully to determine</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;what types of facilities qualify for benefit payments, and to determine that</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;payment for a covered service will be made if you move to a state that has a</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;different licensing scheme for facilities than the one in which you purchased</span></font></p> </td> </tr> <tr> <td width=120 valign=top style='width:90.25pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;</span></font></p> </td> <td width=530 valign=top style='width:397.15pt;padding:0in 5.4pt 0in 5.4pt'> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt'>&nbsp;&nbsp;&nbsp;&nbsp;the policy.</span></font></p> </td> </tr> </table> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman">&nbsp;</font></p> <p class=MsoNormal><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html>