Instructions For Form 8853 - 2016 Page 7
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8Filing Requirements for Section C
Go through this chart for each insured person for
whom you received long-term care (LTC)
payments. See Definitions, earlier.
Start Here
Did you (or your spouse, if
Were any of those
ling jointly) receive
payments made
payments in 2016 made on
Complete all of
Yes
Yes
under a qualified LTC
a per diem or other periodic
Section C
insurance contract?
basis under an LTC
insurance contract?
No
No
Did you (or your spouse, if
Did you (or your spouse, if
ling jointly) receive any
ling jointly) receive any
Complete only lines
accelerated death bene ts in
accelerated death bene ts in
14a, 14b, and 17 of
2016 from a life
2016 from a life insurance
No
Section C
insurance policy that were
policy that were made on a
made on a per diem or
per diem or other periodic
other periodic basis?
basis?
Yes
Were any of the payments
Complete only lines 14a,
paid on behalf of a
14b, 15, 16, 17 (if
Yes
No
No
chronically ill (not terminally
applicable), and 26 of
ill) individual?
Section C
Yes
Don’t complete
Complete all of Section C
Section C
days (from March 1 through May 31) and the
LTC period is 245 days (from May 1 through
Generally, don't include on line 24
second LTC period is 214 days (from June 1
December 31).
any reimbursements for qualified LTC
!
through December 31).
services you received under a
Line 22
CAUTION
contract issued before August 1, 1996.
Qualified LTC services are necessary
However, you must include reimbursements if
You can choose this method even if you
diagnostic, preventive, therapeutic, curing,
the contract was exchanged or modified after
have more than one qualified LTC insurance
treating, mitigating, and rehabilitative services,
July 31, 1996, to increase per diem payments
contract covering the same period. For
and maintenance or personal care services
or reimbursements.
example, you have one insurance contract that
required to treat a chronically ill individual under
pays $100 per day from March 1, 2016, through
Multiple Payees
a plan of care prescribed by a licensed health
December 31, 2016, and you have a second
care practitioner.
insurance contract that pays $1,500 per month
If you checked “Yes” on lines 15 and 16 and the
from March 1, 2016, through December 31,
Line 24
only payments you received were accelerated
2016. You have one LTC period because each
death benefits that were paid because the
Enter the reimbursements you received or
payment rate doesn't vary during the LTC
insured was terminally ill, skip lines 17 through
expect to receive through insurance or
period of March 1 through December 31.
25 and enter -0- on line 26.
otherwise for qualified LTC services provided
However, you have two LTC periods if the facts
for the insured for LTC periods in 2016. Box 3 of
are the same except that the second insurance
In all other cases in which you checked
Form 1099-LTC should indicate whether the
contract didn't begin making payments until
“Yes” on line 15, attach a statement duplicating
payments were made on a reimbursement
May 1, 2016. The first LTC period is 61 days
lines 18 through 26 of the form. This statement
basis.
(from March 1 through April 30) and the second
should show the aggregate computation for all
Instructions for Form 8853 (2016)
-7-
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