NGL Long Term Care

State:

Policy Type:

Single

Joint

Association Premium Discount:

Yes

No

Primary Insured:

Date of Birth:

Gender:

Male

Female

Rate Class:

Secondary Insured:

Date of Birth:

Gender:

Male

Female

Rate Class:

Allowed age range is 40 - 79

Primary Insured Benefit Amount:

Secondary Insured Benefit Amount:

Shared Benefit Amount:

Premium Amount:

The step-rated inflation option will cause the premium to increase by $ annually.

AT POLICY ISSUE

Premium Paid

$0.00

LTC Benefits

$0.00

ROP at Death

$0.00

Surrender Value

$0.00

Benefits at policy issue payable up to $ per day.

AT AGE 85*

Premium Paid

$0.00

LTC Benefits

$0.00

ROP at Death

$0.00

Surrender Value

$0.00

Benefits at age 85 payable up to per day.

*assumes a claim at age 85 at which time premiums would be waived - premiums are calculated from policy issue through age 84
This is only a quote. Actual premiums may vary by up to one dollar for every thousand dollars of premium. This quote is a general description of benefits selected and is not a policy contract. It is not to be used without the Outline of Coverage for the state listed above. Please refer to the policy for the actual premiums. Product underwritten by National Guardian Life Insurance Company (NGL). National Guardian Life Insurance Company is not affiliated with The Guardian Life Insurance Company of America a.k.a. The Guardian or Guardian Life.

AGENT INFORMATION

Agent Name:

Agent Email:

Agent Phone:

CA License No.

CLIENT INFORMATION

Primary Insured Name:

Secondary Insured Name: