Module Summary Activity

<%@LANGUAGE="JAVASCRIPT" CODEPAGE="65001"%> Module Summary Activity

Long-Term Care Partnership

Initial Protection

Process Introduction

LTCP Initial Determination

HealthQuest Response

Module Summary Activity

This module’s purpose was to give you a brief introduction to the forms you will be using throughout the LTCP processes. More information about when and how to use the forms will be discussed in the upcoming modules as we discuss the LTCP processes.

Try to identify the use of each of the forms listed below before clicking on the form number to check your answer.

DHS-5426: Brochure that provides LTCP information.

DHS-5426A: Authorizes DHS and the LTC insurance company to share information about the client’s LTC insurance policy.

DHS-5426B: Allows the insurance company to provide information to DHS about the client’s LTC insurance policy and LTC benefits provided.

DHS-5426C: Notifies the client of the PAL amount, and allows the client to protect assets.

DHS-5426D: Allows the client to report the value of protected assets at annual renewal.

DHS-5426E: Allows the LTC insurance company to provide information about additional LTC benefits paid since the request for MA-LTC or the last annual renewal.

Conclusion icon.

Conclusion icon.

This is the end of the module.

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LTCP Forms

Updated September 21, 2021.
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