Note the Group Policy and Division Numbers
Group Policy Number
Division Numbers
Step 1. Review Your Plan Details
Familiarize yourself with the details of your plan.
If you resided in a state listed below when you initially purchased your coverage, or you are purchasing new coverage and you reside in a state listed below, then use the link for that state to determine your rate. Otherwise, use the rates in Section 1 above.
Step 2. Important Information About Your Enrollment
Please read and print the following documents for your records. These are state required documents to assist with long term care insurance decisions. Nothing in this section needs to be returned in order to apply during your initial enrollment, unless it is also specified as a required form for enrollment in your section below.
Should you wish to complete forms in paper versus electronically, please contact LTC Solutions, Inc. at LTCiBenefitsTeam@ltc-solutions.com or 877-286-2852.Step 3. Employee Enrollment
Employee Enrollment FormChoose your plan options and submit the form.
Long Term Care Insurance Application (1116-01) with HIPPA Authorization (6720-03-CA)(Evidence of Insurability - Medical Questionnaire)Required if you enroll after the Guarantee Issue enrollment period, or choose benefits over the Guarantee Issue limits.
Check List of Delivered Forms (7600-04)Required to be returned by insurer.
Request to Change Coverage (AE-1181)Required if you are currently enrolled and would like to change your coverage.
Step 4. Spouse/Domestic Partner/CA Registered Domestic Partner Enrollment
All spouse/registered domestic partner/domestic partner coverage is medically underwritten. The Long Term Care Insurance Application must be completed along with the Enrollment Form.
Spouse/Domestic Partner/CA Registered Domestic Partner Enrollment FormChoose your plan options and submit the form.
Long Term Care Insurance Application (1116-01) with HIPPA Authorization (6720-03-CA)(Evidence of Insurability Medical Questionnaire)Required by Insurer
Step 5. Family Enrollment
Family coverage is medically underwritten. The Long Term Care Insurance Application must be completed along with the Enrollment Form. To apply for coverage, complete these forms.
Family Enrollment FormChoose your plan options and submit the form.
Be sure to read the documents in section two above.
Eligible family members who would like to apply for coverage require these additional form(s):
LTC Personal Worksheet (7625-04-CA)
3rd Party Notice of Prem Lapse (7606-04)
Authorization & Agreement for Auto Payments (7713-04)
You may have enrolled in the Unum Long-Term Care (LTC) insurance plan offered through through your employer, which helps protect you, your independence, and your future. If you have left employment, you can continue your plan by being directly billed by Unum.
To continue your Unum LTC insurance plan, the following is required:
Receive your initial Unum billing statement when it arrives (within 30 days) or check for your electronic funds transfer. If you do not receive a bill or statement from Unum within 30 days, please call LTC Solutions at (877) 286-2852 and Unum at (866) 679-3054.
Pay your initial Unum billing statement when it arrives or check for your electronic funds transfer.
Verify your payment was deducted from your bank account. If your bank account does not show your payment, then you have not continued your Unum LTC plan. This means you do not have LTC insurance. It is your responsibility to verify payments are being processed with Unum.