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Insured's Information
Date of Birth
Gender
-Gender-
Male
Female
Resident State
--Select One--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
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
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Tobacco Use
-Tobacco Use-
Have Used in the Last 12 Months
Do Not Use Tobacco
Coverage
Health Class
-Select Health-
Exceptionally healthy (Preferred Plus)
Very healthy (Preferred)
Above average health (Standard Plus)
Average health (Standard)
Payment Options
-Select-
Universal Life - Single Pay
Universal Life - 10 Pay
Universal Life - 20 Pay
Universal Life - Pay to 65
Universal Life - Pay to 100
Universal Life - No Lapse U/L
Coverage Amount
-Select Amount-
Enter Specific Amount
$25,000
$50,000
$75,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$275,000
$300,000
$325,000
$350,000
$375,000
$400,000
$425,000
$450,000
$475,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
$900,000
$950,000
$1,000,000
$1,100,000
$1,200,000
$1,300,000
$1,400,000
$1,500,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
$8,000,000
$9,000,000
$10,000,000
$11,000,000
$12,000,000
$13,000,000
$14,000,000
$15,000,000
$16,000,000
$17,000,000
$18,000,000
$19,000,000
$20,000,000
$21,000,000
$22,000,000
$23,000,000
$24,000,000
$25,000,000
Specific Coverage Amount
Underwriting Type
Full Underwriting
Abbreviated Underwriting
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Help Me Decide: Payment Options
In general, younger people select longer life insurance policies, while people closer to retirement pick shorter terms.
The goal for most people when choosing a coverage length is to protect their loved ones throughout their income-earning years when their unexpected death would leave loved ones most vulnerable to financial hardship.
Need help deciding?
Just answer a few simple questions.
Get Started
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I need coverage for:
My entire life
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How many years until your dependents are living on their own and/or complete with college?
I have no dependents (other than my spouse)
1-5 years
6-10 years
11-15 years
16-20 years
21-25 years
26 years or more
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How many years would you like to provide income replacement for your spouse?
1-5 years
6-10 years
11-15 years
16-20 years
21-25 years
26 years or more
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How many years do you have left on your mortgage?
None
1-5 years
6-10 years
11-15 years
16-20 years
21-25 years
26 years or more
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Based on your answers, the best option for you is:
Select
×
Help Me Decide: Health Class
When you apply for life insurance, the underwriter will rate your overall health and lifestyle and assign you to a risk class. These risk classes dictate how much you will pay for life insurance. To get the best quote possible, you should choose the health class that best represents you.
Need help deciding?
Just answer a few simple questions.
Get Started
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Have you had any major health impairments, such as diabetes, cancer or heart disease?
No
Yes
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Do you have any family history (parent or sibling) of heart disease or cancer?
No
Prior to Age 65
Prior to Age 60
Death Prior to Age 60
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Do you have any history of substance abuse in the last 8 years?
No
Yes
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How is your blood pressure?
135/85 or Better (Untreated)
140/90 or Better
145/90 or Better
Higher Than 145/90
Unsure
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How is your cholesterol/HDL ratio?
4.5 or Under
5.5 or Under
6.0 or Under
Over 6.0
Unsure
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Do you participate in hazardous activities (work or recreational)?
No
Yes
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Start Over
How many moving violations in the last 3 years?
None
2 or Less
3 or More
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How many DUIs in the last 5 years?
None
1
2 or More
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Your
estimated
best health class you would likely qualify for is:
Select
Health Class Options
Exceptionally healthy
(Preferred Plus)
Very healthy with no history of major impairments, hazardous activities or substance abuse.
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You have no health impairment history (diabetes, cancer, heart disease, substance abuse, etc)
No family history (parent or sibling) of heart disease or cancer prior to age 65
Your blood pressure and cholesterol are under excellent control
No hazardous activities (work or recreational)
You have not had more than 2 moving violations or DUI in past 5 years
Select
Very healthy
(Preferred)
Good health with no history of major impairments or substance abuse.
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You have no health impairment history (diabetes, cancer, heart disease, substance abuse, etc)
No family history (parent or sibling) of heart disease or cancer prior to age 60
Your blood pressure and cholesterol are under excellent control
You may participate in certain hazardous activities (work or recreational)
You have not had more than 2 moving violations or DUI in past 5 years
Select
Above average health
(Standard Plus)
Some minor health impairments, moving violations and some hazardous activities.
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You may have some minor health impairments
No family history (parent or sibling) of heart disease or cancer deaths prior to age 60
Your blood pressure and cholesterol are under good control
You may participate in certain hazardous activities (work or recreational)
You have not had more than 2 moving violations or DUI in past 5 years or substance abuse history in the last 7 years
Select
Average health
(Standard)
Some health impairments, blood pressure or cholesterol issues, and moving violations.
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You may have some health impairments
Your blood pressure and/or cholesterol may be slightly elevated
You have had more than 2 moving violations or a DUI in the past 5 years, or substance abuse history in the last 7 years
Select
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Help Me Decide: Coverage Amount
Coverage amount (also known as death benefit) is the sum of money paid to the beneficiaries of the life insurance policy after the insured's death. Use the tools below to determine an adequate amount of coverage.
Need help deciding?
Just answer a few simple questions and get a quick needs analysis.
Get Started
Next
Income Needs
Type in a value or use the dial to enter a value for each input below.
Total Income Needed
(Annual income needed)
×
Total Income Needed
Enter the total annual income your family would need if you were to die today. This value should represent the minimum amount you need to maintain your current lifestyle. If you are unsure, just enter your current income.
Spouse/Other Income
(All other annual income)
Years of
Income Needed
Income
Next
Debt and Expenses
Type in a value or use the dial to enter a value for each input below.
Funeral Expense
(All funeral expenses)
Mortgage
(Outstanding balance)
Other Debt
(All other debt balances)
Monthly Debt Payments
(All monthly debt payments)
Education Expense
(Cost per child)
Number Children
Income
Debt
Next
Savings and Existing Insurance
Type in a value or use the dial to enter a value for each input below.
Total Savings
(Willing to use towards debt)
Existing Life Insurance
(Sum of all policies)
Income
Debt
Savings
Needs Analysis Result
Needs
Immediate Needs
$
Long-Term Needs
$
Total Needs
$
Resources
Savings
$
Existing Insurance
$
Spouse's Earnings
$
Total Resources
$
Results
Additional Life Insurance Needed
$
Apply This Amount
* Assuming investable assets earn interest at a rate of 3% annually.
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Help Me Decide: Underwriting Type
Accelerated underwriting may be a possibility if your client can answer “no” to the following questions:
Has your client received treatment for or been prescribed medication for any major medical condition within the past 5 years?
Within the past 24 months has your client been:
Declined by another life insurance carrier?
Hospitalized for a psychiatric or medical reason (other than orthopedic related injury)?
Filed for Bankruptcy?
Disabled or collected Social Security Income benefits for more than six months?
In the past 10 years has your client been charged with a felony conviction, DUI, or reckless driving?
Has your client ever sought or received advice, counseling or treatment for the use of alcohol or drugs, including prescription medications?
Within the last ten years, have you ever been treated for, or diagnosed as having a heart condition, chest pain, stroke, cancer, diabetes, alcohol abuse or drug dependency?
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