Effective April 1, 2026, the Long-Term Care Personal Worksheet is being updated for all states except California and Florida. The only change is an update to the Rate Increase History Grid. This applies to both paper and e-applications.
Key Dates
• New forms effective: April 1, 2026
• Old forms cutoff: April 30, 2026
Old Personal Worksheets received after April 30, 2026, will not be accepted. A new Personal Worksheet will be required.
Updated Forms:
- ICC23-470484_2026 replaces ICC23-470484 — AL, AK, AR, CO, GA, ID, IL, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, NE, NV, NH, NM, NC, OH, OK, OR, PA, PR*, RI, TN, TX, UT, VT, VA, WA, WV, WI, WISE*, WY
- ICC23-470484_SPPR_2026 replaces ICC23-470484_SPPR — PR Spanish*
- 470484_2026 replaces 470484 — AZ, CT, DE, DC, HI, IN, MT, NJ, NY, ND, SD
- 470484_SC_2026 replaces 470484_SC — SC
Application Options
The worksheet is included in the LTC application packet and cannot be ordered standalone. Packet covers now show “_2026” instead of “_2025” (except CA & FL). Examples: MAP622_2026 replaces MAP622_2025 (National – AK, MS, PR, UT, WV), MAP622_AL_2026 replaces MAP622_AL_2025, and similar for other states.
Please use 2026 application packets starting April 1, 2026 and retire 2025 versions by April 30, 2026.
LTC Personal Worksheet Updates – Effective April 1, 2026
Questions? Call our Marketing Team at 800-842-7799!
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