Let's get started

What would you like your coverage to do?

Choose the one that matters most. You can talk through the rest with your advisor.

Who would the policy cover?

Please choose who the policy would cover.

About how much coverage are you considering?

A range is fine. Your advisor can help you fine-tune it.

Not sure? Use our coverage calculator (opens in a new tab).

What kind of policy, and when do you need it?

Type of coverage

When would you like coverage to start?

Please answer both questions.

Date of birth and sex

Age and sex are the starting point for every insurer's pricing.

Month

Day

Year

Sex assigned at birth

Please enter a valid date of birth (ages 18 to 85) and choose an option.

Where do you live, and what's your height and weight?

ZIP code

Coverage options vary by state.

Height

Weight (lbs)

Why we ask

Insurers use height and weight to set your health class. Accurate answers help your advisor find the insurer most likely to offer you their best rates.

Please enter a valid ZIP code, height and weight.

What do you do for work?

Most jobs don't affect your price, but a few do.

Occupation

Annual household income

Why we ask about income

Insurers limit coverage to a multiple of income. Knowing your range helps your advisor recommend an amount you can actually be approved for.

Please enter your occupation and choose an income range.

Have you used any nicotine or tobacco products?

Include anything used in the last 5 years. Choose all that apply.

When did you last use any of these?

Why we ask

Nicotine use is one of the biggest factors in pricing, and insurers test for it. Some insurers treat cigars or marijuana more favorably than cigarettes, so the details help.

Please choose at least one option, and when you last used it.

Driving and activities

DUI, DWI or license suspension in the last 5 years?

Do you take part in any of these? Choose all that apply.

Please answer each question.

Health snapshot · Part 1 of 2

Have you ever been diagnosed with or treated for any of these?

Your best recollection is fine. Answers are shared only with your advisor and insurers you choose to apply with.

Encrypted · shared only with your licensed advisor · How we protect it ↗

Heart disease, heart attack or stroke

Which condition, and about when?

CancerNot including basal cell skin cancer

Type of cancerTime since treatment ended

Diabetes

TypeTreatmentMost recent A1C

High blood pressure

Is it well controlled?

High cholesterol

Is it well controlled?

Based on this, your advisor will likely recommend a fully underwritten policy rather than a no-exam one. That's normal, and it often gets a better price for your situation.

Please answer each question, including any follow-up details.

Health snapshot · Part 2 of 2

A few more health questions

COPD, emphysema or asthma

Which condition, and do you use oxygen?

Kidney or liver disease

Please describe briefly

Sleep apnea

Do you use a CPAP machine regularly?

Anxiety, depression or another mental health condition

Have you been hospitalized for it in the last 5 years?

Hospitalized overnight in the last 2 years?Not including childbirth

What was the reason?

Any tests, surgery or specialist visits recommended but not yet done?

What is pending?

Currently need help with daily activities, or live in a nursing home?

Did a parent or sibling die of heart disease or cancer before age 60?

How many prescription medications do you take?

Thanks for the detail. Some of these answers mean your advisor will look at insurers that review each case individually. That takes a little longer but usually finds better options.

Anything else your advisor should know? (optional)

Please answer each question, including any follow-up details.

Do you have life insurance today?

About how much coverage in total? Are you thinking about replacing or cancelling a current policy?

Please answer the question, including the follow-up details.

Almost there

Does everything look right?

Tap Edit to change anything. Your answers are saved as you go.

Last step

Where should we send your options?

A licensed advisor will review your answers and follow up with personalized pricing.

First name

Last name

Email

Mobile phone

Best time to reach you

Preferred contact method

Please complete every field and check the consent box.

Thank you. Your request has been received.

A licensed advisor will review your information and contact you within one business day to discuss your options and provide accurate pricing.

Reference number Q-000000

Prefer to choose a time?

Schedule a free, no-obligation call with a licensed advisor.

What happens next

An advisor reviews your answers and compares insurers that fit your health and budget.
We reach out by your preferred method to confirm a few details and share accurate pricing.
If you choose a policy, we help you apply. There's no cost to you and no obligation.

Helpful to have ready: a list of your current medications and your doctor's name. Final rates are determined by the insurance company after underwriting.

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