<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>span { white-space: pre-wrap; } p.s18e441fa-2d57-4b59-a6fd-56e827e7b522Footer { font-family: Times; font-size: 12pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } span.s18e441fa-2d57-4b59-a6fd-56e827e7b522000000 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } p.s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal { font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } p.s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001 { text-align: center; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } span.s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont { font-family: 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New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-right: 0; margin-bottom: .001pt; } p.s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000007 { margin-left: 0.40in; text-indent: -0.40in; text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-right: 0; margin-bottom: .001pt; } p.s18e441fa-2d57-4b59-a6fd-56e827e7b522BodyTextIndent { margin-left: 0.60in; text-indent: -0.60in; text-align: justify; font-family: Times; font-size: 12pt; line-height: 108%; margin-top: 0; margin-right: 0; margin-bottom: .001pt; } p.s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000008 { font-family: Times; font-size: 12pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } span.s18e441fa-2d57-4b59-a6fd-56e827e7b522000009 { font-size: 10pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Footer"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">DEPARTMENT OF LABOR AND REGULATION</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">DIVISION OF INSURANCE</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">OUTLINE OF COVERAGE</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Chapter 20:</span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">06:21</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">APPENDIX A</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">SEE: §</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">20:06:21:28</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000001"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000003">Source:</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont"> 22 SDR 97, effective </span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">December 18, 1995; 28 SDR 157, effective </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">May 19, 2002.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000005"><br />&#x200e;</span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000003">Appendix A.</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont"> Outline of Coverage. Note: A slant mark indicates alternatives. Parentheses indicate instructions or blanks to be filled in. The remaining language is intended to be used verbatim.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    The caution statement referred to in §</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">20:06:21:28 must appear as follows in the outline of coverage:</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000006"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        Caution: The issuance of this long-term care insurance policy/certificate is based upon your responses to the questions on your application. A copy of your application/enrollment form is enclosed/was retained by you when you applied. If your answers are incorrect or untrue, the company has the right to deny benefits or rescind your policy. The best time to clear up any questions is now, before a claim arises! If, for any reason, any of your answers are incorrect, contact the company at this address: (insert address).</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000007"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (1)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">This policy is an individual policy of insurance/a group policy which was issued in (indicate the jurisdiction in which the group policy was issued).</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (2)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Purpose of outline of coverage. This outline of coverage provides a very brief description of the important features of the policy. You should compare this outline of coverage to outlines of coverage for other policies available to you. This is not an insurance contract, but only a summary of coverage. Only the individual or group policy contains governing contractual provisions. This means that the policy or group policy sets forth in detail the rights and obligations of both you and the insurance company. Therefore, if you purchase this coverage, or any other coverage, it is important that you </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000003">READ YOUR POLICY OR CERTIFICATE CAREFULLY!</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (3) Federal tax consequences.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        This [POLICY] [CERTIFICATE] is intended to be a federally tax-qualified long-term care insurance contract under Section 7702B(b) of the Internal Revenue Code of 1986, as amended.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal"><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">OR</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    Federal Tax Implications of this [POLICY] [CERTIFICATE]. This [POLICY] [CERTIFICATE] is not intended to be a federally tax-qualified long-term care insurance contract under Section 7702B(b) of the Internal Revenue Code of 1986 as amended. Benefits received under the [POLICY] [CERTIFICATE] may be taxable as income.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (4)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Terms under which the policy or certificate may be continued in force or discontinued.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (a)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(For long-term care health insurance policies or certificates describe one of the following permissible policy renewability provisions:)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">            (i)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(Policies and certificates that are guaranteed renewable shall contain the following statement:) </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000003">RENEWABILITY: THIS POLICY OR CERTIFICATE IS GUARANTEED RENEWABLE</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">. This means you have the right, subject to the terms of your policy or certificate to continue this policy as long as you pay your premiums on time. (Company Name) cannot change any of the terms of your policy on its own, except that, in the future, </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000003">IT MAY INCREASE THE PREMIUM YOU PAY</span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">         (ii)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(Policies and certificates that are noncancelable shall contain the following statement:) </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000003">RENEWABILITY: THIS POLICY OR CERTIFICATE IS NONCANCELABLE</span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">. This means that you have the right, subject to the terms of your policy, to continue this policy as long as you pay your premiums on time. (Company Name) cannot change any of the terms of your policy on its own and cannot change the premium you currently pay. However, if your policy contains an inflation protection feature where you choose to increase your benefits, (Company Name) may increase your premium at that time for those additional benefits.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (b)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(For group coverage, specifically describe continuation/conversion provisions applicable to the certificate and group policy.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (c)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(Describe waiver of premium provisions or state that there are no such provisions.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (5) Terms under which the company may change premiums.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522BodyTextIndent"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        [In bold type larger than the maximum type required to be used for the other provisions of the outline of coverage, state whether or not the company has a right to change the premium, and if a right exists, describe clearly and concisely each circumstance under which the premium may change.]</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (6)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Terms under which the policy or certificate may be returned and premium refunded:</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (a)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(Provide a brief description of the right to return/"freelook" provision of the policy.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (b)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(Include a statement that the policy either does or does not contain provisions providing for a refund or partial refund of premium upon the death of an insured or surrender of the policy or certificate. If the policy contains such provisions, include a description of them.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (7)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">This is not Medicare supplement coverage. If you are eligible for Medicare, review the Medicare Supplement Buyer's Guide available from the insurance company.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (a)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(For agents,) neither (insert company name) nor its agents represent Medicare, the federal government, or any state government.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (b)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(For direct response,) (insert company name) is not representing Medicare, the federal government, or any state government.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (8)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Long-term care coverage. Policies of this category are designed to provide coverage for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care unit of a hospital, such as in a nursing home, in the community, or in the home.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    This policy provides coverage in the form of a fixed dollar indemnity benefit for covered long-term care expenses, subject to policy limitations/waiting periods and coinsurance requirements. (Modify this paragraph if the policy is not an indemnity policy.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (9)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Benefits provided by this policy:</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (a)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(List covered services, related deductibles, waiting periods, elimination periods, and benefit maximums.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (b)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(List institutional benefits, by skill level.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (c)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(List noninstitutional benefits, by skill level.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (Any additional benefit screens must also be explained in this section. A benefit screen is a provision in a policy or certificate that an insured must meet to qualify for benefits. If these screens differ for different benefits, explanation of the screen should accompany each benefit description. If an attending physician or other specified person must certify a certain level of functional dependency in order to be eligible for benefits, this must be specified. If activities of daily living (ADLs) and cognitive impairment are used to measure an insured's need for long-term care, these qualifying criteria or screens must be explained and described as part of the outline of coverage.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (10)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Limitations and exclusions. (Describe the following:)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (a)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Preexisting conditions.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (b)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Ineligible facilities/provider.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (c)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Ineligible levels of care, e.g., unlicensed providers or care or treatment provided by a family member.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (d)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Exclusions/exceptions.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (e)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Limitations.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (This section should provide a brief specific description of any policy provisions which limit, exclude, restrict, reduce, delay, or in any other manner operate to qualify payment of the benefits described in subdivision (9) above.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000003">THIS POLICY MAY NOT COVER ALL THE EXPENSES ASSOCIATED WITH YOUR LONG-TERM CARE NEEDS.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (11)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Relationship of cost of care and benefits. Because the costs of long-term care services will likely increase over time, you should consider whether and how the benefits of this plan may be adjusted, (As applicable, indicate the following:</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (a)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">That the benefit level will not increase over time;</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (b)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Any automatic benefit adjustment provisions;</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (c)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Whether the insured will be guaranteed the option to buy additional benefits and the basis upon which benefits will be increased over time if not by a specified amount or percentage;</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (d)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">If there is such a guarantee, include whether additional underwriting or health screening will be required, the frequency and amounts of the upgrade options, and any significant restrictions or limitations; and</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (e)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Describe whether there will be any additional premium charge imposed and how it is to be calculated.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (12)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Alzheimer's disease and other organic brain disorders.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (State that the policy provides coverage for insureds clinically diagnosed as having Alzheimer's disease or related degenerative and dementing illnesses. Specifically describe each benefit screen or other policy provision which provides preconditions to the availability of policy benefits for such an insured.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (13)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Premium.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (a)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(State the total annual premium for the policy.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (b)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(If the premium varies with an applicant's choice among benefit options, indicate the portion of annual premium which corresponds to each benefit option.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (14)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">Additional features.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (a)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(Indicate if medical underwriting is used.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">        (b)</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000002"> </span><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">(Describe other important features.)</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000000"> </span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000004"><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont">    (15) CONTACT THE STATE SENIOR HEALTH INSURANCE ASSISTANCE PROGRAM IF YOU HAVE GENERAL QUESTIONS REGARDING LONG-TERM CARE INSURANCE. CONTACT THE INSURANCE COMPANY IF YOU HAVE SPECIFIC QUESTIONS REGARDING YOUR LONG-TERM CARE INSURANCE POLICY OR CERTIFICATE.</span></p><p dir="ltr" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522Normal-000008"><span class="s18e441fa-2d57-4b59-a6fd-56e827e7b522DefaultParagraphFont-000005"><br />&#x200e;</span><span xml:space="preserve" class="s18e441fa-2d57-4b59-a6fd-56e827e7b522000009"> </span></p></div></body></html>