Form 1099-Ltc - Long-Term Care And Accelerated Death Benefits - 2016 Page 5
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7Instructions for Insured
A payer, such as an insurance company or a viatical
Box 1. Shows the gross benefits paid under a long-term
settlement provider, must give this form to you and to the
care insurance contract during the year.
policyholder for payments made under a long-term care
Box 2. Shows the gross accelerated death benefits paid
insurance contract or for accelerated death benefits.
during the year.
Payments include both benefits you received directly and
Box 3. Shows if the amount in box 1 or 2 was paid on a
expenses paid on your behalf to third parties.
per diem basis or was reimbursement of actual long-term
If you are the insured but are not the policyholder, Copy
care expenses. If you are terminally ill, this box may not be
C is provided to you for information only because these
checked.
payments are not taxable to you. If you are also the
Box 4. May show if the benefits were from a qualified long-
policyholder, you should receive Copy B.
term care insurance contract.
Insured's identification number. For your protection, this
Box 5. May show if you were certified chronically ill or
form may show only the last four digits of your social
terminally ill, and the latest date certified.
security number (SSN), individual taxpayer identification
Future developments. For the latest developments related
number (ITIN), adoption taxpayer identification number
to Form 1099-LTC and its instructions, such as legislation
(ATIN), or employer identification number (EIN). However,
enacted after they were published, go to
the issuer has reported your complete identification
form1099ltc.
number to the IRS.
Account number. May show an account or other unique
number the payer assigned to distinguish your account.
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