Long-Term Care

Why sell LTCi with Ritter?

• More than half of people turning 65 by 2019 will require long-term care during their lifetimes.
• About 15 million Americans are expected to have a long-term care need by 2050.
• LTCi plans are much more affordable and attainable before a client’s health deteriorates.

Ritter is at the forefront of the long-term care insurance industry. Our carrier partners lead the way with traditional products and long-term care alternatives such as hybrid and annuity/LTCi combination products. As the LTC landscape changes, our partners continue to develop innovative ways to provide essential coverage to a growing population.

Get Professional Help

For Professional LTC Help please contact our strategic partners at Advisors Insurance Brokers (AIB) at 800-724-8977:

• Traditional LTC support - Melissa Frasier x115
• Traditional LTC & Linked Benefit support - Jennifer Brown x126
• Linked Benefit Support - David Michalski x100
• Agents may also request service and support via at [email protected]

Prescreen Questionnaire

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Name *

Email Address *

Phone Number *

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Resident State *

Resident State * Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Applicant Name *

Gender *

Male Female

Date of Birth *

Height *

Weight *

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Marital Status *

Single Married

In the past 5 years, have you used any tobacco products? *

Yes No

If yes, what type/how often?

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Do you currently require assistance with any of the following activities? *

Bathing | Continence | Dressing | Eating | Toileting | Walking

Yes No

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Have you ever been confined to a nursing or rehabilitation facility? *

Yes No

If yes, please explain when and for what reason.

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Have you had, do you currently have, or have you ever been medically diagnosed as having any of the following?

Arthritis (Osteo/Rheumatoid) AIDS/HIV High Blood Pressure Muscular Dystrophy Liver Disease Cancer Memory Loss

Depression/Anxiety Multiple Sclerosis Dizziness/Falls Osteoporosis/Fractures Asthma/COPD Kidney Disease Stroke or TIA

Diabetes (Type I/Type II) Joint Replacements Alzheimer's Disease/Dementia Heart Disease Parkinson's Disease Sleep Disorders

If you answered yes, please include for each condition, date of diagnosis, treatment received, and if you are still under treatment.

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Please complete the following chart to reflect any prescription medications you have taken in the past 12 months.

Medication Name	Prescribed For	Current Dosage/ Taken How Often	Indicate Changed Made to dosage in past 12 months.	Have you stopped taking it, even though it is prescribed? If so, why?
Medication Name	Prescribed For	Current Dosage / Taken How Often	Indicate Changed Made to dosage in past 12 months.	Have you stopped taking it, even though it is prescribed? If so, why?
Medication Name	Prescribed For	Current Dosage / Taken How Often	Indicate Changed Made to dosage in past 12 months.	Have you stopped taking it, even though it is prescribed? If so, why?
Medication Name	Prescribed For	Current Dosage / Taken How Often	Indicate Changed Made to dosage in past 12 months.	Have you stopped taking it, even though it is prescribed? If so, why?
Medication Name	Prescribed For	Current Dosage / Taken How Often	Indicate Changed Made to dosage in past 12 months.	Have you stopped taking it, even though it is prescribed? If so, why?

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Have you been hospitalized, consulted with or been treated by a medical professional for any reasons not listed above?

Yes No

If yes, please explain. Please include date diagnosed, treatment received, and if you are still under treatment.

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Are you currently under any post-operative care, like physical therapy?

Yes No

If yes, please explain. Please include date diagnosed, treatment received, and if you are still under treatment.

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Have any surgeries or tests been recommended that have yet to be completed?

Yes No

If yes, please explain.

Have you ever been declined for long term care insurance, life insurance, or disability insurance?

Yes No

If yes, please explain.

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Do you qualify for payment or are you receiving disability income or social security disability?

Yes No

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Do you have a handicap parking permit?

Yes No

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