Revised Pre-Authorized Premium Paying Service forms

Revised Pre-Authorized Premium Paying Service forms The “Pre-Authorized Check (PAC) Premium Payment Service forms used to request ongoing PAC premium payments for the EssentialLTC Product have been revised effective October 1, 2021. There are two versions of this PAC form, which vary by state. Form Name: New Form Number: Replaced Form Number: Form utilized in: Pre-Authorized Check (PAC) Premium Payment Service ICC16-NLTCAPA 09/21 ICC16-NLTCAPA Compact Approved states: AK, AL, AR, CO, GA, IA, ID, IL, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, NE, NH, NM, NV, OH, OK, OR, PA, RI, SC, TN, TX, UT, VA,
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