To begin, select the product or service you're interested in receiving a quote for.*

Medicaid Compliant Annuity

Long-Term Care Insurance

Funeral Expense Trust

Tax-Deferred Annuity

Non-Compliant Annuity Valuation

What is your professional designation?*

Attorney or attorney support staff

Insurance agent or financial advisor

I'm a consumer seeking a quote for myself or a loved one

Please provide us some additional information about yourself before we get to the client's information.

Please provide us some additional information about you.

Name*

First Last

Email*

Phone*

Company Name*

Address*

Street Address City State ZIP Code

Facsimile

Are you seeking a quote for yourself or for a loved one?*

Myself

Loved one

What is your relationship to this person?

Thank you! Now, tell us what kind of quote you're looking for.*

I already know the annuity term and premium amount. I just need a quick quote.

I would like you to provide a comprehensive proposal and calculate the annuity term and premium amount for my client's case.

Preferred Planner

Next, let's learn more about the client or clients. Is the client married?*

Yes

No

Is one spouse applying for Medicaid or are both spouses applying for Medicaid?*

One spouse

Both spouses

Next, let's learn more about you. Are you married?*

Yes

No

Are both you and your spouse interested in applying for LTC or are you only interested in applying for yourself?*

Both of us

Just me

Are you currently working with an agent, advisor, or other financial professional for long-term care?*

Yes

No

Please provide the name and title of the professional you've been working with:

Next, let's learn more about the client or clients. Is the client married?*

Yes

No

Is one spouse interested in applying for LTC or are both spouses interested in applying for LTC?*

One spouse

Both spouses

Client Data

What is the proposed owner/annuitant's name?*

First Last

What is the proposed owner/annuitant's date of birth?*

State of Residence*

What is the desired face value?*

Additional Comments

Client Data

What is the owner of the annuity's name?*

First Last

State of Residence*

Contract Data

What insurance company holds the contract?

Is this a qualified or non-qualified annuity?

Qualified

Non-qualified

At what frequency does the client receive regular payments?

Monthly

Quarterly

Semi-annually

Annually

How much does the contract pay at the selected frequency?

Is this a lifetime contract?

Yes

No

When is the next guaranteed payment date?

When is the last guaranteed payment date?

How many remaining payments does the contract guarantee?

Additional Comments

START A PROPOSAL

Client Information

Medicaid Compliant Annuity Information

Client Information

Gross Monthly Income

Cost of Care

Assets and Liabilities

Client Information

Gross Monthly Income

Medicaid Applicant

Community Spouse

Cost of Care

Shelter Expenses

Assets and Liabilities

Client Information

Medications

Your Medications

Your spouse's medications

Health History

Your Health History

Your Spouse's Health History

Additional Health Questions

Your Additional Health Questions

Your Spouse's Additional Health Questions

Income Information

Your Income Information

Your Spouse's Income Information

Asset Information

Client Information

Medications

Applicant

Co-applicant

Health History

Applicant

Co-applicant

Additional Health Questions

Applicant

Co-applicant

Income Information

Applicant

Co-applicant

Asset Information

Client Information

Financial Information

Additional Questions

Client Data

Client Data

Contract Data