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Qualified Long-Term Care Insurance Contract - benefits are not taxable.  Since box 4 is checked you have nothing to report. 
A contract issued after 1996 is a qualified long-term care
insurance contract if it meets the requirements of section 7702B,
including the requirement that the insured must be a chronically
ill individual (see Chronically Ill Individual, later). A contract
issued before 1997 is generally treated as a qualified long-term
care insurance contract if it met state law requirements for
long-term care insurance contracts and it has not been materially changed.