Is your family prepared for your future? Let us educate you about your LTC options! Call us Today at 270-495-7500

FREE Quote

Request your customized analysis today

To receive your FREE policy comparisons
and quote, please complete this simple,
secure form:

(mm/dd/yyyy)

Not in KY? Not a problem! We are happy to recommend a LTCi specialist in YOUR area.

Do You Need Long Term Care Insurance?

Let our LTCi Specialists walk you through
your all your options!

START NOW..

Kentucky Partnership Kentucky has designed the Partnership program to motivate individuals to take personal responsibility for their own care by purchasing long-term care insurance. Read more

Beware of Quotes Getting quotes on this type of insurance is A LOT like buying shoes online. What are the odds that they will actually fit? NOT likely! Read more

Contact a LTCi Specialist "The right way to buy insurance!
No problem!
No Obligation!
Ever."

Let us walk you through one of the most important decisions of your adult life!
Read more


#1 In Identity Theft Protection
Client
Name
D.O.B.
Height
Weight
Spouse
Name
D.O.B.
Height
Weight
1. Are you taking prescription medications? Please list meds /doses / conditions below..
Client Yes   No
Spouse Yes No

2. Do you currently use oxygen, crutches, cane, wheelchair or receive physical therapy?.
Client Yes   No
Spouse Yes No

3. Have you been declined for LTC insurance? If yes, please provide details below..
Client Yes   No
Spouse Yes No

4. Have you used tobacco in the last 36 months?.
Client Yes   No
Spouse Yes No

5. Are you scheduled for surgery in the next 6 months or is surgery recommended?.
Client Yes   No
Spouse Yes No

6. Have you been hospitalized in the last 10 years? Please list dates, treatment & details..
Client Yes   No
Spouse Yes No

7. Have you applied for or are you eligible for Medicaid?.
Client Yes   No
Spouse Yes No

8.Have you been diagnosed or received treatment for any of the following conditions:.

a. Anxiety/Depression, Migraines, Fractures, Arthritis, Osteoporosis, High Blood Pressure.
Client Yes   No
Spouse Yes No



b. Bypass Angina, Stroke, Heart Attack, TIA, Congestive Heart Failure Surgery.
Client Yes   No
Spouse Yes No



c. Diabetes, Peripheral Vascular Disease, Fibromyalgia Lupus, Atrial Fibrillation Aneurysm.
Client Yes   No
Spouse Yes No



d. Carotid Artery Disease, Prostate Disorders, Macular Degeneration, Cancer, OTHER.
Client Yes   No
Spouse Yes No

Please list ALL medications and details to any “Yes” answers to the questions above:
Client:
Spouse:

KY Senior Insurance
www.KYseniorInsurance.com
info@KYseniorInsurance.com
phone (270)495-7500 fax (270) 904-6194

Recommended books

Insurance for Dummies by Jack Hungelmann

The New Savage Number by Terry Savage

Bogelheads Guide to Retirement Planning

9 Steps to Financial Freedom by Suze Orman

 

Site Designed by SIS Media Group