Form 1099-Ltc - Long-Term Care And Accelerated Death Benefits - 2016 Page 3
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7Instructions for Policyholder
individuals who are certified as chronically ill are excludable from income to the
A payer, such as an insurance company or a viatical settlement provider, must
same extent they would be if paid under a qualified long-term care insurance
give this form to you for payments made under a long-term care insurance
contract.
contract or for accelerated death benefits. Payments include those made
directly to you (or to the insured) and those made to third parties.
Policyholder's identification number. For your protection, this form may show
only the last four digits of your social security number (SSN), individual taxpayer
A long-term care insurance contract provides coverage of expenses for long-
identification number (ITIN), adoption taxpayer identification number (ATIN), or
term care services for an individual who has been certified by a licensed health
employer identification number (EIN). However, the issuer has reported your
care practitioner as chronically ill. A life insurance company or viatical settlement
complete identification number to the IRS.
provider may pay accelerated death benefits if the insured has been certified by
either a physician as terminally ill or by a licensed health care practitioner as
Account number. May show an account or other unique number the payer
chronically ill.
assigned to distinguish your account.
Long-term care insurance contract. Generally, amounts received under a
Box 1. Shows the gross benefits paid under a long-term care insurance contract
qualified long-term care insurance contract are excluded from your income.
during the year.
However, if payments are made on a per diem basis, the amount you may
Box 2. Shows the gross accelerated death benefits paid during the year.
exclude is limited. The per diem exclusion limit must be allocated among all
Box 3. Shows if the amount in box 1 or 2 was paid on a per diem basis or was
policyholders who own qualified long-term care insurance contracts for the
reimbursement of actual long-term care expenses. If the insured was terminally
same insured. See Pub. 525 and Form 8853, and its instructions for more
ill, this box may not be checked.
information.
Box 4. May show if the benefits were from a qualified long-term care insurance
Per diem basis. This means the payments were made on any periodic basis
contract.
without regard to the actual expenses incurred during the period to which the
Box 5. May show if the insured was certified chronically ill or terminally ill, and
payments relate.
the latest date certified.
Accelerated death benefits. Amounts paid as accelerated death benefits are
Future developments. For the latest developments related to Form 1099-LTC
fully excludable from your income if the insured has been certified by a
and its instructions, such as legislation enacted after they were published, go to
physician as terminally ill. Accelerated death benefits paid on behalf of
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