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Page 2 of 2 Fileid: … I1099LTC/201910/A/XML/Cycle04/source 15:14 - 24-Oct-2019
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
toileting, transferring, bathing, dressing, and continence) for at Truncating recipient’s TIN on payee statements. Pursuant
least 90 days due to a loss of functional capacity; or to Regulations section 301.6109-4, all filers of this form may
2. Requiring substantial supervision to protect the individual truncate a recipient’s TIN (social security number (SSN),
from threats to health and safety due to severe cognitive individual taxpayer identification number (ITIN), adoption
impairment. taxpayer identification number (ATIN), or employer identification
number (EIN)) on payee statements. Truncation is not allowed
Terminally Ill Individual on any documents the filer files with the IRS. A payer's TIN may
not be truncated on any form. See part J in the current General
A terminally ill individual is someone who has been certified by a Instructions for Certain Information Returns.
physician as having an illness or physical condition that can
reasonably be expected to result in death in 24 months or less Account Number
after the date of certification. The account number is required if you have multiple accounts for
a recipient for whom you are filing more than one Form
Reporting 1099-LTC. Additionally, the IRS encourages you to designate an
Report payments only if the policyholder is an individual. account number for all Forms 1099-LTC that you file. See part L
Reportable payments are those made to the policyholder, to the in the current General Instructions for Certain Information
insured, or to a third party. Returns.
You may report benefits paid from each contract on a
separate Form 1099-LTC. At your option, you may aggregate Box 1. Gross Long-Term Care Benefits Paid
benefits paid under multiple contracts on one Form 1099-LTC if Enter the gross long-term care benefits paid this year (other than
the same information is reportable on the form for each contract accelerated death benefits). These benefits are all amounts paid
(other than the amount of benefits paid). out on a per diem or other periodic basis or on a reimbursed
basis. It includes amounts paid to the insured, to the
Policyholder policyholder, and to third parties. You are not required to
determine whether any benefits are taxable or nontaxable.
The policyholder is the individual who owns the contract,
including the owner of a contract sold or assigned to a viatical Box 2. Accelerated Death Benefits Paid
settlement provider. In the case of a group contract, the term
“policyholder” includes the certificate holder (or similar Enter the gross accelerated death benefits paid under a life
participant). You must report long-term care benefits to the insurance contract this year to or on behalf of an insured who
policyholder even if the payments were made to the insured or to has been certified as terminally or chronically ill. Include the
a third party (for example, a nursing home, caretaker, or amount paid by a viatical settlement provider for the sale or
physician). The policyholder may also be the insured. assignment of the insured's death benefit under a life insurance
contract.
Enter the name, address, and TIN of the policyholder on
Form 1099-LTC. If the policyholder is not an individual, no Box 3. Check if Per Diem or Reimbursed
reporting is required. Amount
Check a box to indicate whether the payments were made on a
Insured per diem or other periodic basis or on a reimbursed basis. For
The insured is the chronically or terminally ill individual on whose accelerated death benefits, do not check a box if you made
behalf long-term care benefits are paid. payments on behalf of a terminally ill person. “Per diem basis”
means payments made on any periodic basis without regard to
Enter the name, address, and TIN of the insured on Form actual expenses. “Reimbursed basis” means payments made for
1099-LTC. actual expenses incurred.
Box 4. Qualified Contract (Optional)
Statement to Policyholder and Insured
Check the box to indicate whether long-term care insurance
If you are required to file Form 1099-LTC, you must furnish a benefits are paid from a qualified long-term care insurance
statement or acceptable substitute to both the policyholder and contract. See Qualified Long-Term Care Insurance Contract,
to the insured as shown. earlier.
IF the statement is for the ... THEN use... Box 5. Check if Chronically Ill or Terminally Ill
Policyholder Copy B (Optional)
Check the box to indicate whether the insured was chronically or
Insured Copy C terminally ill. Also, enter the latest date certified. If the insured
Policyholder and the policyholder is Copy B (Copy C is optional) was neither chronically nor terminally ill, leave this box blank.
the insured See Chronically Ill Individual and Terminally Ill Individual, earlier.
For more information about the requirement to furnish a
statement to the policyholder and to the insured, see part M in
the current General Instructions for Certain Information Returns.
-2- Instructions for Form 1099-LTC (Rev. 10-2019)
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