- Box 1- The Portion of Gross LTC Payments paid. Check box 4 to see if the contract was qualified.
- Box 2- Amount of accelerated death benefits
- Box 3- Were the payment made on a per diem basis or a reimbursement basis.
- Box 4- Is this a qualified LTC contract?
- Box 5- Chronically or terminally ill?
Long Term Care insurance contracts issued:
- after 1996 must meet section 7702B requirements (including the individual is chronically ill) to be considered qualified
- before 1997 are treated as qualified if they meet state law requirements
If you have a qualified Long Term Care Insurance Contract, please enter the information here:
- Federal Section
- Deductions - Select My Forms
- Adjustments to Income
- Medical Savings Account Form 8853
- Scroll down to Long Term Care Insurance Contracts and enter your information