Quote Tools

Term and GUL – Instant Quote

To access to the full quote tool, including the ability to input client’s medications and conditions to get instant answers on what carriers to use, please submit your request here.

Agent First Name

Agent Last Name

Agent Email

Agent Phone

Client First Name

Client Last Name

Client Gender

Client DOB

State

Tobacco User

Yes No

Height

Weight

List all prescription medications - Include dosages and frequency

List any significant health conditions - Include how treated and when diagnosed

Death Benefit Amount Desired (If ultimate goal is Cash Value Growth, we want to minimize this at first)

Primary Goal for Permanent Insurance

Cash Value Accumulation (IUL) Guaranteed Death Benefit (GUL) Guaranteed Cash Value AND Death Benefit (Most Costly - Whole Life)

Agent First Name

Agent Last Name

Agent Email

Agent Phone

Client First Name

Client Last Name

Client Gender

Client DOB

State

Tobacco User

Height

Weight

List all prescription medications - Include dosages and frequency

List any significant health conditions - Include how treated and when diagnosed

Any history of the following conditions? Select all that apply.

Mental Health Conditions Nerve or Back Disorders Diabetes Any Other Significant Health Conditions

Provide details to "Yes" answers above, including dates of diagnosis and how the condition(s) are treated.

Employment

Self-Employed w2 Employee Unemployed

Please list occupation and duties

Annual Salary (If Self-Employed - Net Earnings After Expenses)

If Applicable, Current Disability Insurance Amount

Type of current disability coverage (Group or Individual)

Policies $50,000 and above only. If below this amount, please use the Final Expense Quote Tool above.

Agent First Name

Agent Last Name

Agent Email

Agent Phone

Client First Name

Client Last Name

Client Gender

Client DOB

State

Tobacco User

Height

Weight

List all prescription medications - Include dosages and frequency

List any significant health conditions - Include how treated and when diagnosed

Previous Declinations (If Applicable)

Life carrier who declined policy

Date of the decline

Reason for the decline

Common impaired risk health issues (info we need if it applies)

Diabetes

Date Diagnosed

How is it treated? (diet, oral medication, insulin)

What was most recent A1C reading?

Any complications? (neuropathy, vision, kidney, heart issues)

Cancer

Date Diagnosed

Type of cancer

Stage

Class

Type of treatment (surgery, radiation, chemotherapy)

Date of last treatment

Is a pathology report available?

Yes No

Pathology report if available

Heart Disease

Date Diagnosed

Was there a heart attack?

What type of treatment (angioplasty, bypass, medical management)?

How many vessels were involved?

What was the date of the last stress test and doctor visit?

Are the stress test results available?

Yes No

Are risk factors being modified (cholesterol, blood pressure, smoking, build, regular exercise)?

Any current symptoms? (chest pain, shortness of breath, fatigue)

Stress Test Results if available

Carrier Underwriting Guides

iPipeline

Height and Weight Chart

iPipeline

Quote Tools

Tool

Link

Common impaired risk health issues (info we need if it applies)