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When were you born?
It's never too late to get life insurance.
What is your gender?
Did you know? Women pay 5% less than men on average.
Where do you live?
Out agents are licensed in all 50 states.
Do you use nicotine products?
This includes cigarettes, cigars, smokeless tobacco and vaping.
Great for you! When did you last use nicotine?
This includes cigarettes, cigars, smokeless tobacco and vaping.
Are you a United States Citizen?
O say can you see, by the dawn's early light...
Are you a Permanent Resident?
O say can you see, by the dawn's early light...
Please select what is applicable to you:
I am currently hospitalized or in a facility
I have a life expectancy of 12 months or less
I had an application or reinstatement request for life, health or disability insurance declined or postponed
This policy will replace an existing life insurance policy
Some life insurance companies are unable to replace a current life insurance policy. Are you ok with applying for an additional policy instead?
Sure, I can cancel my current policy on my own if I choose to.
No, I want the insurance company to automatically replace a policy.
To help qualify you, we need to ask you some additional health questions.
This should only take about 1-2 minutes.
Please select what is applicable to you:
Currently prescribed to use oxygen for any lung or respiratory disorder
Have pending diagnostic tests or surgery
Currently dependent on a wheelchair
Have been convicted to a felony
How long ago were you convicted of a felony?
Within the past 24 months
Between 25 months and 5 years
Over 5 years ago
None of these are applicable to me
Have you been diagnosed, treated, or had surgery for any of the following:
Any condition requiring bone marrow, stem cell, or organ transplant
Kidney disease requiring dialysis
Alzheimer's Disease, dementia, mental incapacity
Lou Gehrig's Disease (ALS)
Human Immunodeficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS), or AIDS Related Complex (ARC)
Congestive heart failure or cardiomyopathy
None of these are applicable to me
Have you ever been diagnosed with any of the following:
Multiple sclerosis
Diabetes
Do any of the below apply to you?
Were you diagnosed prior to the age of 40? Yes No
Is in combination with any heart or circulatory disorder diagnosed by a medical professional? Yes No
Requires 40 or more units of insulin daily? Yes No
Parkinson's disease
Heart disease
When were you last treated by a medical professional for your heart?
Within the past 12 months
It has been between 13 - 24 months
It has been between 2 - 5 years
It has been over 5 years
Crohn's disease
Cancer
When were you last treated by a medical professional for cancer?
Within the past 12 months
It has been between 13 - 24 months
It has been between 2 - 5 years
It has been over 5 years
Leukemia
Stroke
When were you last treated by a medical professional for leukemia?
Within the past 12 months
It has been between 13 - 24 months
It has been between 2 - 5 years
It has been over 5 years
When were you last treated by a medical professional for the stroke?
Within the past 12 months
It has been between 13 - 24 months
It has been between 2 - 5 years
It has been over 5 years
Cerebral palsy
Aneurysm
When were you last treated by a medical professional for the aneurysm?
Within the past 12 months
It has been between 13 - 24 months
It has been between 2 - 5 years
It has been over 5 years
Cirrhosis
Lupus
When were you last treated by a medical professional for lupus?
Within the past 12 months
It has been between 13 - 24 months
It has been between 2 - 5 years
It has been over 5 years
None of these are applicable to me
You could qualify for term life insurance instead
To qualify for final expense, you need to be older than age 55.
Good news though, you could qualify for term life insurance instead, which could save you money as well!!