Benefit Reduction Options – Quote Selection Sheet

{Stat Company}

Long Term Care Insurance Rate Increase

Benefit Reduction Options ? Quote Selection Sheet

Prepared for Policy Number: {policy number}

If you are concerned about the upcoming rate increase (see rate increase letter) and you want to keep your premium amount closer to your current premium amount, please review the benefit reduction options and quotes presented in this document. If, however, you plan to pay the increased premium and do not want to reduce your benefits, you may disregard this document.

How to select a benefit reduction option. Review the options displayed in the Quote Selection Sheet at the end of this document. To select an option, place a check in the box next to the option you want. After you've checked an option, sign and date the Quote Selection Sheet and mail it to us in the enclosed envelope or fax it to {XXX-XXX-XXXX}.

Before you make your selection, please visit our website at options. for more information. If you have questions or would like to learn about other options that may be available, please use the website to schedule a phone call from us--at a time that's convenient for you--or call us directly at 866-311-2048.

Your policy's current benefits are summarized below. By reducing or adjusting a benefit, you may be able to reduce your premium.

Summary of Your Policy's Current Benefits

Benefit Name Benefit Increase Option (BIO) Rate Nursing Home - Maximum Daily Nursing Home - Maximum Lifetime* Nursing Home - Elimination Period Nursing Home/Assisted Living - Maximum Daily Nursing Home/Assisted Living - Maximum Lifetime* Nursing Home/Assisted Living - Elimination Period Community Based Services - Maximum Daily Community Based Services:

Professional Services (Level 1) ? Maximum Daily Basic Services (Level II) ? Maximum Daily Community Based Services/Assisted Living - Maximum Daily Community Based Services/Assisted Living - Maximum Daily Community Based Services - Maximum Daily Community Based Services - Maximum Lifetime* Community Based Services - Elimination Period

Current Benefit {rate%} ${amount} {Unlimited or XXX} Days [AND/OR] {$amount} {XX} days ${amount} {Unlimited or XXX} Days {XX} days ${amount}

${amount} ${amount}

{Unlimited or XXX} Days [AND/OR] {$amount} {XX} Days

* If any claims have been paid, actual lifetime amount may be less.

Considering your options. To see how reducing a benefit could reduce your premium, please review the Quote Selection Sheet at the end of this document. You can use the Quote Selection Sheet to select a benefit reduction option that best fits your budget and coverage needs. Please be aware that

not all options are equal and some will impact your coverage and premium more than others. And keep in mind that changes to your coverage may or may not be in your best interest and should be considered carefully, especially if you are on claim, or are eligible to claim, or if your policy has the survivorship benefit and you think that you will soon be eligible to claim this benefit.

Current Benefit and Reduced Benefit. Each option below is displayed in a table that shows a Current Benefit and a Reduced Benefit. The Current Benefit is your benefit today. It reflects any benefit changes requested by you after the start of your policy. The Reduced Benefit shows the benefit you are choosing if you select the option.

[Add the following section for policies with BIO] Current Value and Reduced Value. You purchased a Benefit Increase Option (BIO) with your policy that automatically increases your benefit amount annually. Please note that the amount shown in the Current Benefit column does not include any increase in value accumulated through your BIO. BIO increases are reflected in the Current Value column, which shows the cumulative effect of your BIO rate on your Current Benefit amount as of {Month XX, 20XX}. The Reduced Value column shows the value that would result if you select the option.

Reducing your BIO rate or removing BIO. You may have the option to reduce your BIO rate or to remove BIO from your policy altogether. If you reduce your BIO rate, you will retain previously accumulated increases. If you remove your BIO altogether, you will lose previously accumulated increases. [End of BIO section]

Maximum Lifetime Benefit. If you have incurred any claims under your policy, your maximum lifetime benefit may have been reduced by the amount of the claims paid. The amount or value of a maximum lifetime benefit shown in the Quote Selection Sheet--whether current or reduced--does not reflect possible reductions to the lifetime benefit as a result of claims paid.

Reduced Premium quote. Each option on the Quote Selection Sheet displays your Increased Premium, if you do not select a benefit reduction option, and a Reduced Premium, if you select the option.

Please be aware that the Reduced Premium displayed is a QUOTE only and IS NOT A GUARANTEE of any rate(s) quoted or a revision of your current policy contract. Actual premium(s) may differ slightly. Premium calculations are based on information and policy coverage as of {Month XX, 20XX}. If you select one of the options below, your policy will be endorsed to reflect the actual premium.

Contingent Nonforfeiture Benefit ? another option. If you do not pay your premium when it becomes due, your current coverage will lapse. To prevent you from forfeiting (losing) the premiums you have already paid, we will provide a Contingent Nonforfeiture Benefit. The Contingent Nonforfeiture Benefit is not a cash value benefit. It provides benefit dollars only if you become eligible for and receive covered benefits.

This nonforfeiture benefit will allow your coverage to continue in a limited form without further premium payments. Although your daily benefit amount and elimination period will remain the same, your maximum lifetime benefit will be reduced to an amount equal to the total amount of the premiums you have already paid. Benefit increases under your Benefit Increase Option (if you have one) will stop. You will not be allowed to resume payment of premiums or make changes to your policy.

The Contingent Nonforfeiture Benefit will take effect automatically, if you stop paying your premiums within the 120 days following the Rate Increase Effective Date. This nonforfeiture benefit will not be available to policyholders who cease paying premiums at any other time.

Note: The Contingent Nonforfeiture Benefit provides very limited benefits. We urge you to carefully consider whether or not such limited benefits are appropriate for you. You may want to call our customer service representatives, or your insurance agent, to discuss the Contingent Nonforfeiture Benefit in greater detail.

Other options. Options not shown on this quote sheet may also be available to you. For example, you may be able to reduce more than one benefit. To explore other benefit reduction options, you will need to speak with a customer service representative. Go to options. to schedule a call from us or call us at 866-311-2048.

[Add the following section for Partnership policies] Partnership Qualified Long Term Care Policies ? Loss of Medicaid asset protection. Depending on your state and age, if you choose to remove your policy's Benefit Increase Option (BIO), your policy will no longer qualify as a Long Term Care Partnership policy and you will not be eligible for Medicaid asset protection. If you choose to reduce your policy's Benefit Increase Option (BIO), your policy may no longer qualify as a Long Term Care Partnership policy. Reducing your maximum daily benefit or your maximum lifetime benefit could also cause your policy to no longer qualify as a Long Term Care Partnership policy.

We strongly encourage you to evaluate the potential impact any benefit reduction option could have on your Long Term Care Partnership policy and Medicaid asset protection. Please contact a customer service representative or speak with a trusted advisor before you select an option.

If you have a Long Term Care Partnership policy and you select a benefit reduction option, you must sign the Loss of Medicaid Asset Protection Acknowledgement at the end of the Quote Selection Sheet. [End section for Partnership policies]

For more information. We encourage you to visit options. for more information about your coverage and options. You can use the website's online scheduling tool to arrange a time for a customer service representative to call you--a time that is convenient for you and any family members, friends, or advisors that you would like to have on the call with you.

After visiting the website, you may have additional questions. Please feel free to call our Long Term Care Insurance customer service representatives at 866-311-2048. Our dedicated representatives are available during normal business hours to answer questions. Additional representatives will be available Monday through Friday between 4:00 p.m. and 8:00 p.m. ET to respond to questions about the premium increase.

Quote Selection Sheet

To select an option, place a check in the box next to the option you want. After you have checked an option, sign and date the Quote Selection Sheet and mail it to us in the enclosed envelop or fax it to {XXX-XXX-XXXX}. If you have questions or would like information about the other options that may be available, contact us at 866-311-2048 before you make your selection.

[ Option 1: Reduce Maximum Lifetime Benefit

Benefit Nursing Home Lifetime Home Health Lifetime*

Current Benefit Reduced Benefit

$204,400

$153,300

$50,000

$25,000

Current Value $347,480 $85,000

Reduced Value $260,610** $42,500**

* Pooled with Maximum Nursing Home Lifetime ** Reflects BIO applied to Reduced Benefit from policy start date. If any claims have been paid, actual lifetime amount may be less.

Mode Quarterly

Increased Premium $216.67

Reduced Premium $182.97

Option 2: Reduce Maximum Daily Benefit

Benefit Nursing Home Daily Home Health Daily Nursing Home Lifetime Home Health Lifetime*

Current Benefit $140 $100

$204,400 $50,000

Reduced Benefit $120 $80

$175,200 $40,000

Current Value $238 $170

$347,480 $85,000

Reduced Value $204** $136**

$297,840*** $68,000***

* Pooled with Maximum Nursing Home Lifetime ** Reflects BIO applied to Reduced Benefit from policy start date. *** If any claims have been paid, actual lifetime amount may be less.

Mode Quarterly

Increased Premium $216.67

Reduced Premium $203.45

Option 3: Reduce Benefit Increase Option (BIO) Rate

Benefit BIO RATE Nursing Home Daily Home Health Daily Nursing Home Lifetime Home Health Lifetime*

Current Benefit 5%

$140 $100 $204,400 $50,000

Reduced Benefit 2.75% -

Current Value -

$238 $170 $347,480 $85,000

Reduced Value -

$238** $170** $347,480*** $85,000***

* Pooled with Maximum Nursing Home Lifetime ** Retains BIO increases accumulated at old rate. Future increases will occur at reduced rate. *** Retains BIO increases accumulated at old rate. Future increases will occur at reduced rate. If any claims have been paid, actual lifetime amount may be less.

Mode Quarterly

Increased Premium $216.67

Reduced Premium $177.52

Option 4: Reduce Benefit Increase Option (BIO) Rate

Benefit BIO Rate Nursing Home Daily Home Health Daily Nursing Home Lifetime Home Health Lifetime*

Current Benefit 5%

$140 $100 $204,400 $50,000

Reduced Benefit 0% -

Current Value -

$238 $170 $347,480 $85,000

Reduced Value -

$238** $170** $347,480*** $85,000***

* Pooled with Maximum Nursing Home Lifetime ** Retains BIO increases accumulated at old rate. No future increases will occur. *** Retains BIO increases accumulated at old rate. No future increases will occur. If any claims have been paid, actual lifetime amount may be less.

Mode Quarterly

Increased Premium $216.67

Reduced Premium $190.92

Option 5: Remove Benefit Increase Option (BIO) Rider

Benefit Nursing Home Daily Home Health Daily Nursing Home Lifetime Home Health Lifetime*

Current Benefit $140 $100

$204,400 $50,000

Reduced Benefit $140 $100

$204,400 $50,000

Current Value $238 $170

$347,480 $85,000

Reduced Value $140** $100**

$204,400*** $50,000***

* Pooled with Maximum Nursing Home Lifetime ** Reflects loss of accumulated BIO increases. No future increases will occur. *** Reflects loss of accumulated BIO increases. No future increases will occur. If any claims have been paid, actual lifetime amount may be less.

Mode Quarterly

Increased Premium $216.67

Reduced Premium $108.36

Option 6: Increase Elimination Period

Elimination Period Nursing Home Home Health

Current Period 60 Days 0 Days

Increased Period 90 Days 30 Days

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