Long-Term Care insurance forms
Everything you need to proactively manage all aspects of your long-term care account.
All Forms
Assignment of benefits and W-9 form
Use this form to pay your service provider directly.
Automatic deduction plan for insurance premiums
Use this form to authorize withdrawals from your checking/savings account to pay your insurance premium.
Direct deposit form
Use this form to elect to receive a guaranteed income stream from a Legacy variable annuity, with the exception of Accommodator products. IMPORTANT: We have an annuitization form specific to each product. If this is not your product, please click to view the additional forms PDF at the bottom of this page and find the appropriate product form.
HIPAA compliant authorization form
Use this form for trust or entity ownership changes. Examples include contracts owned by trusts, partnerships, corporations, or charitable entities that are not issued in conjunction with a qualified retirement plan.
W-9 form
Use this form to make address and/or name changes on an annuity contract.
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Durable medical equipment claim
Use this form to request reimbursement for Durable Medical Equipment purchases
W-9 form
Use this form to fill out your W-9.
Assignment of benefits and W-9 form
Use this form to pay your service provider directly.
Automatic deduction plan for insurance premiums
Use this form to authorize withdrawals from your checking/savings account to pay your insurance premium.
Direct deposit form
Use this form if you would like your claims payments deposited directly in your checking account.
HIPAA compliant authorization form
Use this form to authorize individuals to whom John Hancock may disclose information regarding your Long-Term Care policy.
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 with LTC riders) and John Hancock Life & Health Insurance Company, Boston, MA 02116 (Long-term care insurance). Long-term care insurance policies issued under the name of Union Security Insurance Company, Union Security Life Insurance Company of New York, American Republic Insurance Company, and Blue Cross/Blue Shield of South Carolina are administered by John Hancock Life Insurance Company (U.S.A.). Policies issued under Time Insurance Company are insured and administered by John Hancock Life Insurance Company (U.S.A.).
MLINY052021283-1