(30-day free examination. Benefits and premiums under this policy may be suspended for up to 24 months if you become entitled to benefits under Medicaid. You must request that your policy be suspended within 90 days of becoming entitled to Medicaid. If you lose (are no longer entitled to) benefits from Medicaid, this policy can be reinstated if you request reinstatement within 90 days of the loss of such benefits and pay the required premium.)

(Our Medicare Supplement product is not available in the following states: AK, AL, CT, HI, MA, ME, NV, NY, VT and WA. Louisiana residents please contact our home office as this form is not available in your state.)

Lincoln Heritage Life Insurance is not connected with or endorsed by the U.S. Government or the federal Medicare program.
MS5 11-05 REV 4-06