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Personal Quote  ▪  Policy Guidelines

Personal Quote

This is a secure page. MAGA takes your privacy very seriously.  Your information will never be used for anything but the purpose for which it was provided and will be held in the strictest confidence.  Personal information will not be given out to third parties.  The complete MAGA privacy policy can be viewed on our privacy page.

 

To receive a customized quote fill in the form and click the Send to MAGA button at the end.

Are you married or in a committed relationship?     Yes     No If yes, is partner applying for coverage?                 Yes     No If partner is applying, complete information under partner column as well.
	Applicant	Partner
Full Name
Address
City	State - - - AL  AK  AZ  AR  CA  CO  CT  DC  DE  FL  GA  HI  ID  IL  IN  IA  KS  KY  LA  MA  ME  MD  MI  MN  MS  MO  MT  NE  NV  NH  NM  NC  ND  NJ  NY  OH  OK  OR  PA  RI  SC  SD  TN  TX  UT  VT  VA  WA  WV  WI  WY    Zip
Phone
E-mail
Date of Birth
Height
Weight
Have you used tobacco products in the last 5 years?
	Yes     No	Yes     No
Have you been hospitalized overnight in the last 5 years? If yes, please indicate when and for what specific reasons? (This information will be kept confidential but is needed to provide the most accurate quote).
	Applicant	Spouse/Partner
Medical History & Medications List medications you are currently taking or have taken in the last 12 months, dosage and reason for taking.
	Applicant	Spouse/Partner

 Select your benefits:

1. Daily Benefit: The maximum daily benefit for care received in a Nursing Home or Alternative Care Facility. Typically, if the full daily benefit is not needed, the difference will be carried over. (How much does it cost? Click here to find the average for your area.)
         - Choose one - $ 50 $ 60 $ 70 $ 80 $ 90 $ 100 $ 110 $ 120 $ 130 $ 140 $ 150 $ 160 $ 170 $ 180 $ 190 $ 200 $ 210 $ 220 $ 230 $ 240 $ 250 $ 260 $ 270 $ 280 $ 290 $ 300 $ 310 $ 320 $ 330 $ 340 $ 350 $ 360 $ 370 $ 380 $ 390 $ 400 $ 410 $ 420 $ 430 $ 440 $ 450 $ 460 $ 470 $ 480 $ 490 $ 500
    
2. Length of coverage: The daily benefit times the length of coverage to get the lifetime maximum dollar amount. Most companies will offer a range of 2 years (730 days), 3 years (1095), 4 years (1460), 5 years (1825), or Lifetime (unlimited). ( An example is 2 years of coverage at $100.00 per day. The lifetime maximum would be $73,000 to pay for care when needed.)
        2 years               5 years
        3 years               10 years
        4 years               Lifetime (unlimited)
    
3. Elimination Period: Synonymous with deductible period. The amount in days that must be satisfied before the benefits are paid. This is usually met once in the lifetime of a policy.
        30 days     60 days     90 days     180 days     365 days
    
4. Home Health Care Benefit: The maximum daily benefit for care received in one's own home. This should cover any level of care needed. Some companies offer a range of 50%, 75% or 100% of the daily facility benefit. Not all companies offer reduced care for the home.
        0% (Facility Only)     50%     75%     100%
    
5. Inflation Protection:  Automatically increases the daily benefit each year on the anniversary of the policy. Designated to ensure the policy one acquires retains its value over the years. Most companies offer the option of no inflation, simple (5%), or compound inflation (5%).
        No Inflation
        Simple Inflation
        Compound Inflation

Additional Information

1. Do you currently have a long term care insurance policy?    Yes     No
2. Have you previously looked into long term care insurance?  Yes     No
3. On a scale of 1 to 10, how familiar are you with long term care insurance?     1=Novice, 10=Expert

Any additional information you would like us to consider?

How did you hear about MAGA Ltd?   - Choose one - Accountant/CPA Advertisement AFTRA Attorney Financial Advisor Insurance Agent/Broker Internet Search - Other Internet Search - Google Internet Search - Yahoo! MAGA Client Morningstar Newspaper/Magazine Article Terry Savage Other Please elaborate (name of Web site or magazine, referrer name, etc.)

Having trouble submitting a quote? Send an email and let us know more.