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Client Information

Medical/Lifestyle Information

Known health issues or prescribed medications:

i.e. Cancer, Coronary Disease, HBP, Osteoporosis, Stroke, etc.

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Long Term Care Rider Definitions

For the payment of an additional premium, we will waive premium payments if you are receiving benefits under your policy, other than for Respite Care, Home Modification, Therapeutic Device, Caregiver Training and Medical Alert System (if the option you selected included those overages).

Non-Forfeiture Rider:

For the payment of an additional premium, this rider provides that if your policy lapses for non-payment of premium after it has been in force for at least 5 years, we will continue coverage at a reduced level under your

Inflation Rider:

Simple 5% Interest or Compound 5% Interest.

Simple:

Provides for an automatic annual increase of your maximum benefit amounts on each anniversary of your rider effective date. Your maximum benefit amounts will be increased each year by an amount equal to 5% of your original maximum benefit amounts each year.

Survivorship Benefit:

For payment of an additional premium, this rider provides that if you and your spouse each purchased a long term care insurance policy, your policy will become paid-up on the later of: (1) the date of your spouse’s death; (2) the 10th anniversary of your policy effective date. Paid-up means that no further premiums will be payable on your policy.

Return of Premium Rider:

For payment of an additional premium, this rider provides that if you die while this policy is in force we will return to your beneficiary, if any, or your estate, all the premium you paid for this policy and any attached riders, reduced by the sum of incurred claims.

Limited Pay Options:

You can pay or pay-up policy 10-20 years, to age 65 or with a single premium.

Restoration of Benefits:

Restore benefits if more than 180 days separate covered charges. This is with benefit period other than unlimited (life).