Section 2012.EXHIBIT L   Long-Term Care Insurance Partnership Disclosure Notice

Long-Term Care Insurance Partnership Disclosure Notice

(Company Name)

(Company Address)

(Policyholder/Certificateholder) Name:

(Policy/Certificate) Number/Identifier:

Effective Date:

Important Information Regarding Your Policy's (Certificate's)

Long-Term Care Insurance Partnership Status

NOTE: Please keep this notice with your long term care insurance policy (certificate)

Partnership Policy (Certificate) Status. Your long-term care insurance policy (certificate) is intended to qualify as a Partnership Policy (Certificate) under the Illinois Long-Term Care Partnership Program as of your Policy's (Certificate's) effective date.

The long-term care insurance policy (certificate) recently purchased and enclosed qualifies for the Illinois Long-Term Care Insurance Partnership Program. Insurance companies voluntarily agree to participate in the Partnership Program by offering long term care insurance coverage that meets certain state and federal requirements. Long-Term Care Insurance Policies (Certificates) that qualify as Partnership Policies (Certificates) may protect your assets through a feature known as "Asset Disregard" under Illinois' Medicaid Program.

Asset Disregard means that an amount of the policyholder's (certificateholder's) assets equal to the amount of long-term care insurance benefits received under a qualified Partnership Policy (Certificate) will be disregarded for the purpose of determining the insured's eligibility for Medicaid. This generally allows a person to keep assets equal to the insurance benefits received under a qualified Partnership Policy (Certificate) without affecting the person's eligibility for Medicaid. In addition, the purchase of this Partnership Policy does not automatically qualify you for Medicaid.

What Could Disqualify Your Policy (Certificate) as a Partnership Policy. If you make any changes to your policy (certificate), such changes could affect whether your policy (certificate) continues to be a Partnership Policy (Certificate). Before you make any changes, you should consult with (carrier name) to determine the effect of a proposed change. In addition, if you move to a state that does not maintain a Partnership Program or does not recognize your policy (certificate) as a Partnership Policy (Certificate), you would not receive beneficial treatment of your policy (certificate) under the Medicaid program of that state. The information contained in this disclosure is based on current Illinois and Federal law. These laws may be subject to change. Any change in law could reduce or eliminate the beneficial treatment of your policy (certificate) under Illinois' Medicaid Program.

Additional Information. If you have questions regarding long-term care insurance policies (certificates), please contact (carrier name). If you have questions regarding current laws governing Medicaid eligibility, you should contact the Illinois Department of Healthcare and Family Services.

(Source:  Added at 38 Ill. Reg. 2186, effective January 2, 2014)