NEW! Enjoy instant, anonymous quotes (we respect your privacy)
Get ready to save. You are about to view
the lowest life insurance rates available
|
Coverage Amount
How
much coverage do I need?
If you are a family breadwinner with dependents,
financial planners suggest carrying ten times your annual
income. If you are a non-working caregiver at home, we
suggest your choice of $150,000 to $500,000. If you are
looking for burial coverage only, we suggest $5,000 to
$25,000.
Click
here to access the Life Happens life insurance needs
calculator.
|
Coverage Estimator Tool
|
|
ZIP & State of Residence
|
|
Birth Date
(Ages 14 Days - 90 Years) |
|
| Gender |
Male
Female
|
|
Any tobacco, nicotine, marijuana,
vape or tobacco substitute use?
Why
do life insurers ask about this?
Nicotine use of any kind, including marijuana use, is
looked at very closely by all life insurers. Smoking,
chewing, inhaling in a vaporized form, consuming in
edible products, and wearing a patch on the skin, all
constitute use of these products. Non-admittance of
marijuana use can result in a decline. Sources of
information the insurer may use include: statements made
on your application, telephone interviews, your paramed
exam results (if one is required), your outside medical
records and your Medical Information Bureau (MIB)
profile. If you currently use marijuana AND any
product containing tobacco or nicotine, please select the
response that most closely describes your tobacco or
nicotine use. Always be 100% honest when you answer
tobacco use questions to ensure accurate quotes.
Remember, a false statement on an application for
insurance could void your coverage.
|
|
|
Height & Weight
|
Height
Weight (with
clothes on)
Why
does the life insurance company need to know your
actual weight?
Weight (with clothes on) is a key rating
factor with all life insurance companies. Please give
an honest answer here so that you can receive
accurate rate quotes. And keep in mind that the
paramed examiner who visits you will be carrying a
portable scale, so be honest here.
|
Non-medical questions that can affect your premium
Did
you think that life insurance companies look only at your
health history? Not true. Today, life insurance companies
look just as closely at many non-medical aspects as they
do at your health. Items looked at very closely include
disability, receiving government benefits, open
bankruptcy, U.S. citizen status, hazardous activities such
as mountain climbing or racing, intended foreign travel to
dangerous countries, private pilot intentions, scuba
diving habits, driving and criminal record status. In
order to receive an accurate rate quote, always be honest
in your answers to these questions.
|
|
Are you now receiving disability payments from any source?
|
No Yes |
|
|
|
Are you now receiving any form of government assistance such as Food Stamps, WIC or Medicaid?
|
No Yes |
|
|
|
In the last 5 years have you had any overdue loans, bankruptcy, judgements, tax liens, collections or debt repayment plans established?
|
No
Yes |
|
Have you had a bankruptcy discharged or established a bankruptcy repayment plan in the last 12 months?
|
No
Yes |
|
Do you now (or have you in the last year) worked at a paying job (employed or self-employed) 20 or more hours per week?
|
No
Yes |
|
|
|
Are you a U.S. Citizen?
|
No Yes |
| What type of
visa do you have? |
|
|
|
|
Do you intend to participate in commercial aviation, private aviation, scuba diving, motorized racing, mountaineering or rock climbing, travel
to any country on the U.S. State Department's
Travel Warnings list, or any other potentially hazardous activities? |
No Yes |
|
|
| Aviation Questionnaire
|
|
| Do you fly as a
pilot or crew member? |
|
|
| Total number of
hours flown as a pilot |
|
| Do you have a valid FAA
Medical Certificate? |
No Yes |
| Class of FAA Medical certificate held |
|
|
|
|
|
|
| Special
issuance or restriction? |
Special
Issuance Restriction
|
| For what condition? |
Weightlifting Instructor
Welder
Wigmaker
Window Decorator
Window Washer
Winery Manager
Winery Supervisor
Winery Worker (Not Field Work)
Woods Worker
Woodworker
Word Processor
Writer (Free-Lance)
Writer (Salaried-Full Time)
X-Ray Technician
Yacht Sales
Zoo Directors
Zoologist
|
|
|
|
|
|
Are you a U.S. Citizen?
|
No Yes |
| What type of
visa do you have? |
|
|
|
|
Do you intend to participate in commercial aviation, private aviation, scuba diving, motorized racing, mountaineering or rock climbing, travel
to any country on the U.S. State Department's
Travel Warnings list, or any other potentially hazardous activities? |
No Yes |
|
|
| Are you a member of
any branch of the military (including Reserves or National Guard)? |
No
Yes |
|
|
| Is all aviation
activity conducted in the United States or Canada? |
No
Yes |
|
|
| Type of
flying as a pilot |
Hours
expected over
next 12 months
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Within the last 5 years, have you been convicted of either reckless driving or driving while under the influence, received 3 or more moving violations or had your license suspended or revoked?
|
No Yes |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Within the last 5 years, have you been convicted of either reckless driving or driving while under the influence, received 3 or more moving violations or had your license suspended or revoked?
|
No Yes |
|
|
|
Have you
ever had a professional license revoked, had a criminal
convictions or law enforcement infraction of any kind or been
on parole or probation?
|
No Yes |
|
|
|
Do you recall
your last blood pressure reading?
Why
am I being asked about my blood pressure?
Hypertension, also called "elevated blood pressure" or
"high blood pressure", is looked at closely by all
life insurance companies. If you don't remember your
last readings, it's OK to choose "I don't know" as
your answer. In that case, we'll assume that you do
not have a history of hypertension and we will show
you the lowest possible rates. If you choose a plan
that requires a paramedical exam, which is really a
face-to-face interview or "mini-medical" then our
technician will check your blood pressure at that
time. If you need personalized advice or help, call
our insurance counselors at
800-752-0074.
|
|
Systolic
|
Diastolic
|
|
|
|
|
| Do you recall what your last cholesterol
level was? |
|
|
| Do you recall what your last cholesterol
ratio was? |
|
|
|
|
| In the past 10
years, have you had or been treated for any of the
following conditions? |
|
|
|
Alcohol Abuse Questionnaire
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Colon Cancer Questionnaire
|
|
| What was the stage
of the cancer? |
|
|
|
|
|
|
| How many polyps
have you had in the last 5 years? |
|
|
|
|
| When was treatment
completed? |
|
|
| When was your last
colonoscopy? |
|
|
|
|
|
|
|
|
|
|
|
|
|
Leukemia Questionnaire
|
| Please
select type of leukemia: |
|
|
|
|
|
|
|
|
|
|
|
| Have any of
the following tests been done? If so, please give date and
results: |
|
|
|
|
|
|
|
|
|
|
| Describe how well this
condition is under control or if it restricts normal life
in any way: |
|
|
|
|
|
|
|
|
Leukemia Questionnaire
|
| Please
select type of leukemia: |
|
|
|
|
|
|
|
|
|
|
|
| Have any of
the following tests been done? If so, please give date and
results: |
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
|
|
|
|
| Please provide
the results of your most recent CBC (complete blood count): |
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
|
Melanoma Questionnaire
|
|
|
|
|
|
|
|
| Please provide
the results of your most recent CBC (complete blood count): |
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
|
Melanoma Questionnaire
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
| Prostate Cancer Questionnaire |
|
| What stage was the
cancer? |
|
|
| What was the PSA level
prior to treatment? |
|
|
| What was the Gleason
score (scale of 1-10)? |
|
|
| Date of biopsy: |
|
|
| How was
the cancer treated? |
|
|
|
|
|
| Date treatment
completed: |
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
| Prostate Cancer Questionnaire |
|
| What stage was the
cancer? |
|
|
| What was the PSA level
prior to treatment? |
|
|
| What was the Gleason
score (scale of 1-10)? |
|
|
| Date of biopsy: |
|
|
| How was
the cancer treated? |
|
|
|
|
|
| Date treatment
completed: |
|
|
| When was the most
recent PSA test? |
|
|
|
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
|
Skin Cancer Questionnaire
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
| Testicular Cancer Questionnaire
|
|
| What was the stage
of the cancer? |
|
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
|
Skin Cancer Questionnaire
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
| Testicular Cancer Questionnaire
|
|
| What was the stage
of the cancer? |
|
|
|
|
|
|
| When was treatment
completed? |
|
|
|
|
|
|
|
|
|
|
|
|
| Date cancer was
declared "in remission": |
|
|
|
|
|
|
|
|
| Describe how well this
condition is under control or if it restricts normal life
in any way: |
|
|
|
|
|
|
|
| Thyroid Cancer Questionnaire
|
|
| What was the stage of
the cancer? |
|
|
|
|
| What type of thyroid cancer was it? |
|
|
|
|
How was the thyroid cancer treated? (Check all that apply)
|
|
|
|
|
|
|
| When was treatment completed? |
|
|
|
|
style="-webkit-box-sizing: border-box; -moz-box-sizing: border-box; box-sizing: border-box; font-size: 11px; display: block; width: 100%; height: 50px; padding: 0; margin: 0 auto; overflow: auto;"
rows="1" cols="1" id="testicularCancer_comments"
name="testicularCancer_comments">
|
|
|
|
|
|
| Thyroid Cancer Questionnaire
|
|
| What was the stage of
the cancer? |
|
|
|
|
| What type of thyroid cancer was it? |
|
|
|
|
How was the thyroid cancer treated? (Check all that apply)
|
|
|
|
|
|
|
| When was treatment completed? |
|
|
|
|
|
|
|
|
|
|
|
|
| Date cancer was
declared "in remission": |
|
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
|
|
|
|
Cancer Questionnaire
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
|
Colitis / Ileitis Questionnaire
|
|
|
|
| Please note the type of
inflammatory bowel disease present: |
|
|
|
|
|
|
|
| Please check if you have had: |
|
|
|
|
|
|
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
|
Colitis / Ileitis Questionnaire
|
|
|
|
| Please note the type of
inflammatory bowel disease present: |
|
|
|
|
|
|
|
| Please check if you have had: |
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
|
COPD Questionnaire
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
|
Crohn's Disease Questionnaire
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
| Anxiety, Depression and Mental Illness Questionnaire
|
|
|
|
|
|
|
Crohn's Disease Questionnaire
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
| Anxiety, Depression and Mental Illness Questionnaire
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
| Diabetes Questionnaire
|
|
| What type of Diabetes? |
|
|
|
|
| What was your most
recent hemoglobin A1c? |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
| Diabetes Questionnaire
|
|
| What type of Diabetes? |
|
|
|
|
| What was your most
recent hemoglobin A1c? |
|
|
| What was your most
recent blood sugar reading? |
|
|
|
|
|
|
|
|
| The diabetes is
controlled by: |
|
|
|
|
|
|
|
| Please check if you have
had any of the following: |
|
|
|
| Describe how well this
condition is under control or if it restricts normal life
in any way: |
|
|
|
|
|
|
|
|
|
|
|
|
|
| Please check if you have
had any of the following: |
|
|
|
| Describe how well this
condition is under control or if it restricts normal life
in any way: |
|
|
|
|
|
|
|
|
Emphysema Questionnaire
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
|
Epilepsy Questionnaire
|
|
|
|
|
|
|
|
Please note type of seizure:
|
|
|
|
|
|
|
|
|
|
|
|
| Describe how well this condition
is under control or if it restricts normal life in any way: |
|
|
|
|
|
|
|
Chronic Pain / Fibromyalgia Questionnaire
|
|
|
|
| Is the pain localized
or widespread? |
| | | | | | | | | | | | | |
Call Us Toll Free: 800-752-0074