Apply for Care Advantage 360

Enrolling with Alicia Nguyen, Gulf Coast Benefits

About you

First name

Last name

Gender

Home phone

Mobile phone

Date of birth

Social Security numberUsed only to confirm one membership per person. It is encrypted and never shown on your dashboard.

Street address Apt / unit

City

State

ZIP

Choose a plan

Two plans. One plan per person.

Care Plan 100 Monthly $100 Daily benefit$100 / day Lifetime value of $36,000* or $1,200 for the first year Care Plan 200 Monthly $200 Daily benefit$200 / day Lifetime value of $72,000* or $2,400 for the first year

There is an initial 180-day waiting period from the membership effective date. A one-time, non-refundable $25 application fee applies. Benefits are paid as an indemnity cash benefit based on days of service rather than a calendar year. Same rate for ages 18–85 with a two-question suitability requirement and no medical underwriting. Benefits, features, and availability are subject to the Membership Terms and Conditions and may vary by state.

*The Lifetime Value could increase to a maximum of $45,000 (Care Plan 100) or $90,000 (Care Plan 200) based on your Future Benefit Amount (FBA). Illustrative only; not guaranteed.

First payment

Monthly — the monthly amount today, then every month Annual — the first year today, then the monthly amount after 12 months Requested effective date

Choose a date within the next 30 days. The membership starts when Senior Optimum Services, LLC accepts it.

Suitability

A Yes on either question means you are not eligible right now.

Will you need care, or do you have surgery scheduled, within the next 180 days?

No Yes

Are you living in a nursing home or assisted living facility, receiving home care, or getting regular help from family or friends with daily activities or memory concerns?

No Yes

Consent

I understand Care Advantage 360 is not insurance and is not a substitute for health insurance, Medicare, Medigap, Medicaid, or long-term care insurance. I agree to sign this application electronically and to receive documents by email.