Form 1099-Ltc - Long-Term Care And Accelerated Death Benefits - Department Of The Treasury - 2013 Page 6

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Instructions for Insured
Box 1. Shows the gross benefits paid under a long-term
A payer, such as an insurance company or a viatical
care insurance contract during the year.
settlement provider, must give this form to you and to
the policyholder for payments made under a long-term
Box 2. Shows the gross accelerated death benefits paid
care insurance contract or for accelerated death
during the year.
benefits. Payments include both benefits you received
Box 3. Shows if the amount in box 1 or 2 was paid on a
directly and expenses paid on your behalf to third
per diem basis or was reimbursement of actual
parties.
long-term care expenses. If you are terminally ill, this
If you are the insured but are not the policyholder,
box may not be checked.
Copy C is provided to you for information only because
Box 4. May show if the benefits were from a qualified
these payments are not taxable to you. If you are also
long-term care insurance contract.
the policyholder, you should receive Copy B.
Box 5. May show if you were certified chronically ill or
Account number. May show an account or other
terminally ill, and the latest date certified.
unique number the payer assigned to distinguish your
Future developments. For the latest developments
account.
related to Form 1099-LTC and its instructions, such as
legislation enacted after they were published, go to

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