Request A Quote Premiums are based on: age, health and benefits. We show you quotes side-by-side so you can compare benefits and premiums. We are not a "lead" company. We do not share or sell your information. The information provided helps us determine which companies will provide coverage. Check all plans you are interested in: Long Term Care Insurance & Partnership Life Insurance with LTC Rider Annuity with LTC Rider If a couple fill out both Quote A and B. Quote A - name or initials: Age Weight: Lbs. Height: (ft-in 5-8) Gender: (M, F) Quote B - name or initials: Age Weight: Lbs. Height: (ft-in 5-8) Gender: (M, F) Marital Status select one Married Partner Single Does either take prescription medications? * Y N Enter medications in box below. Must list medications & health history: * (a) Quote A or B (b) Name of medication (c) What taken for (d) Current or past health issues; surgery, cancer, memory, stroke, narcotic use). Any scheduled or recommended treatments, doctor visits or tests that are no yet completed? Do you currently have a policy? Y N If you have policy click to read. Have you received quotes or are you working with someone who sells insurance? Y N If yes click to read. Your State of residence: quotes are state specific E-mail: (required) Phone: (required) * Medication information helps pre-qualify for insurability, so we can provide accurate information about which companies and which products are available. Providing insurance to clients in all states since 1983. We represent all major companies. Long Term Care is a family affair. The majority of caregivers are family members.