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Current Age	*
State	*
Benefit PeriodA period of time used to calculate the maximum amount the policy will pay (the lifetime maximum benefit amount).	*	3 years 5 years
Inflation ProtectionAutomatically increases the daily benefit amount and lifetime maximum benefit of the policy to help keep pace with inflation.	*	Yes No

	Option 1	Option 2	Option 3	Option 4	Option 5	Option 6	Option 7
Daily Benefit AmountThe maximum amount the policy will pay each day covered long-term care services are received.	$100	$125	$150	$175	$200	$250	$300
Annual Premium AmountThe cost of an insurance policy paid once per year.	$0	$0	$0	$0	$0	$0	$0