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    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.

    Download

    Authorization to receive information (HIPAA)

    Use this form to authorize individuals to whom John Hancock may disclose information regarding your Long-Term Care policy.

    Download

    Automatic deduction plan for insurance premiums

    Use this form to authorize withdrawals from your checking/savings account to pay your insurance premium.

    Download

    LTC address change form

    Use this form to update your address.

    Download

    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.

    Download

    Contact us

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    1-800-377-7311

    Fax (Group) : 800-638-4040 

    Fax (Retail) : 617-572-6010 

     

     

     

     

    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).

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