Life Health Short Term-Gap Supplemental Dental Travel Long Term Care Annuities Student Disability
To apply, either call us at 1-800-722-9053 or request an emailed application or start with this form:
All entries are encrypted and secure. Please be available by telephone to expedite the rest of the process.
All information submitted is under the control of, and supervision by, the insurance licensee. The information is submitted only to the insurance company you name above in accordance with Federal privacy laws and state insurance law and regulation. So that any further requirements can be quickly handled, please be available by telephone.
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IMPORTANT NOTICE:
Do not terminate current life insurance coverage or turn down guaranteed entitlements like COBRA or State continuation which may include life insurance coverage until you receive written confirmation of approval from the insurance company you are applying to. When you receive the insurance contract, which may be called a policy or certificate, you should be sure that you understand and agree with its terms and conditions. You should check the effective date and understand and agree with the coverage offered, and what the premium is.
Rates that have been quoted are not necessarily the rates that all applicants may get and may not be the actual rate that you are offered. Differences may be caused by the insurer's determination of your risk category and any optional benefits that may have been selected. The life insurance company alone will determine the final rate for any applicant according to its underwriting rules.
Rates quoted are also only for the effective date specified. If the actual effective date is different, then the premium may be different for that reason. The premium as of the effective date may or may not be guaranteed for a period of time after the effective date depending on the terms of the insurance contract.
Completion and submission of this form does not complete an application. No life insurance application will be processed and no life insurance coverage will be issued unless you are available to complete all the necessary steps of the application.