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Instant Life Insurance Quotes

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. If you need personalized advice, call our life insurance counselors at 1-800-410-0733 or click here to view our online life insurance needs calculator.
   Needs Calculator
ZIP & State of Residence 
Birth Date
(Ages 14 Days - 85 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. If you need personalized advice, call our life insurance counselors at 1-800-410-0733.
Height & Weight
 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 Life Insurance 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
Have you ever filed for bankruptcy?
No   Yes
Do you work at a paying job (employed or self-employed) 30 or more hours per week?
No   Yes
Annual Income Range:
Are you a U.S. Citizen?
No   Yes
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
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 any other criminal convictions, law enforcement infractions of any kind or been on parole or probation?
No   Yes
Family & Health questions that can affect your Life Insurance premium
Have you ever been rated up or declined by any life insurance company?
No   Yes
Have any of your parents or siblings (biological only), prior to age 60, been diagnosed with or died from:
• Cardiovascular, heart or coronary artery disease, or stroke?
No   Yes
• Cancer, other than basal or squamous cell skin cancer?
No   Yes
Has any doctor recommended any medical test or procedure beyond cosmetic that you have not yet completed?
No   Yes
You've indicated that you have an outstanding medical test or procedure that is not yet completed. We'll show you quotes, but please click Yes to your understanding that those tests will have to be completed before you apply for more than $30,000 of regular life insurance.
Except for the common cold or flu, in the last 10 years have you been diagnosed with, treated for or taken any prescription medication for any medical condition, including any dentist prescriptions?
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 1-800-410-0733.
Are you taking blood pressure medication? No   Yes
Do you recall what your last cholesterol level was?
Do you recall what your last cholesterol ratio was?
Are you taking cholesterol medication? No   Yes
In the past 10 years, have you had or been treated for any of the following conditions?
 Alcohol Abuse  
 Anxiety, ADD or ADHD  
 Drug Abuse or Addiction  
 Gastric/Peptic Ulcers  
 Recurrent Kidney Stones
For what medical conditions have you EVER been diagnosed, treated or prescribed any medication?
 Artery (Coronary) Disease  
 Arthritis (Psoriatic or Rheumatoid)
 Colitis or Ileitis  
 Crohn's Disease  
 Depression or Mental Illness  
 Heart Disease or Abnormal EKG  
 Hepatitis or Liver Disease
 Hypothyroidism (low thyroid)  
 Kidney Disease
 Mitral Valve Prolapse  
 Multiple Sclerosis
 Pain (Chronic & Ongoing)  
 Parkinson's Disease  
 Prostate Issues (no cancer)
 Sleep Apnea  
 Vascular Disease  
Do you have any health conditions or non-medical situations that have not already been disclosed?
No   Yes
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