request a quote    contact us    home Meet The Owner Success Stories Life Insurance Life Insurance FAQs Disability Insurance Disability Insurance FAQs Long Term Care Insurance Long term Care Insurance FAQs Annuities Annuities FAQs Starting A Family Preparing For Illness And Injury Preserving Your Assets Conserving Your Estate Life Insurance   Disability Insurance   Long Term Care Insurance   Annuities Starting a Family   Preparing for Illness and Injury   Preserving your Assets   Conserving your Estate REQUEST A QUOTE LONG TERM CARE INSURANCE Balanced Insurance Group is partnered with the highest-rated insurance companies. To quickly receive multiple quotes from the best companies simply complete the form below or call us direct at (770) 753-3939. "All form fields with an asterisk are mandatory for completion of your quote submission." Name* Address* City* State* --Select-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code* Phone Number*       E-mail Address* Married Yes No Coverage Requested For Spouse Yes No Date Of Birth Month January February March April May June July August September October November December      Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31      Year 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 Spouse Date Of Birth Month January February March April May June July August September October November December      Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31      Year 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 Height, Weight      Height, Weight Of Spouse      Tobacco Use You Yes No Spouse Yes No Daily Benefit Desired $130 $140 $150 $160 $170 $180 $190 $200 $210 $220 Benefit Period Desired 2 years 3 years 4 years 5 years unlimited Inflation Protection none 3% compound 5% simple 5% compound Waiting Period 30 days 60 days 90 days Please Describe Your Health History   This is a security generated graphic code.  Type the text you see in this image. Enter Security Code from above*   Looking for the best price? Looking For An Agent You Can Trust?   Why Balanced Insurance Group? Balanced Insurance Group Partners: © 2009 Balanced Insurance Group     website: 3 DEGREES WEST About BIG      BIG Distinction      Financial Solutions      Insurance Partners      Request A Quote      Contact Us      Home