Long-Term Care forms
Everything you need to proactively manage all aspects of your LTC account.
Agent change
Use this form to change the agent of record for a policy.
Authorization to receive information (HIPAA)
Use this form to authorize individuals to whom John Hancock may disclose information regarding your Long-Term Care policy.
Automatic deduction plan for insurance premiums
Use this form to authorize withdrawals from your checking/savings account to pay your insurance premium.
LTC address change form
Use this form to update your address.
Protection against unintended lapse form
Use this form to designate another person to be notified in the event that your policy is in danger of lapsing.
Contact us
For a list of phone numbers and addresses, visit johnhancockinsurance.com
John Hancock Life and Long-term care insurance products are issued by: John Hancock Life Insurance Company (U.S.A.), Boston, MA 02116 (not licensed in New York); and in New York by John Hancock Life Insurance Company of New York, Valhalla, NY 10595 (Life insurance) and John Hancock Life & Health Insurance Company, Boston, MA 02116 (Long-term care insurance).
MLINY110520282-2