Registration

Registrant Information

Select Your Role *

Your First Name *

Your Last Name *

Policy Number or LTC Coverage ID *

Please enter your 5 to 10-digit policy number or LTC coverage ID. If your policy number is preceded by a 2-digit company code (01 through 07), please exclude this and enter only the last 7 digits of your policy number.

Insured's First Name *

Please enter your First and Last Name as printed on your LTC correspondence.

Insured's Last Name *

Insured's Date of Birth *

Insured's SSN(last 4 digits only) *

Daytime Phone Number *

Email Address *

Confirm Email Address *

Website Access

Username *

Password *

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Passwords are case sensitive and must satisfy all of the following criteria:

At least 8 characters
Upper case letter
Lower case letter
At least one number
At least one special character
Cannot include your first/last name or user id
Cannot have 4 or more sequential or repeated characters (e.g. ABCD,1234,7777)

Please note: Avoid using common words or phrases in passwords in order to improve security strength.

Confirm Password *

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Test password strength to continue *

Security Questions

Select a Question *

Your Answer *

Select a Question *

Your Answer *

Select a Question *

Your Answer *

When Registering

All fields marked with * are required. Username is the name with which you log into the site. Passwords are case sensitive.

Can't Find your Policy Number / LTC Coverage ID? It is printed on your benefit or provider approval letters.

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Registrant Information

Website Access

Security Questions

When Registering

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