Life Insurance Form
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Personal Information

   
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Tobacco/Nicotine Use Please select an item.
Term Please select an item.
Health Class (Choose "Health Class Descriptions" below to determine class) Please select an item.

Health Class Descriptions
Preferred Plus (Best Class)   Preferred
  • No health impairments
  • No history of diabetes, cancer or heart disease
  • No high blood pressure
  • No Cardiovascular disease or cancer in either parent or siblings before age 60
  • No tobacco use in 36-60 months (varies by company)
  • Cholesterol under 220
  • No substance abuse
  • No hazardous activities
  
  • No health impairments
  • No history of diabetes, cancer or heart disease
  • May have controlled blood pressure
  • No Cardiovascular or cancer death in either parent before age 60
  • No tobacco use in last 12-36 months (varies by company)
  • Cholesterol under 250
  • No hazardous activities
     
Standard Plus   Standard
  • Only minor health impairments
  • May have currently controlled blood pressure
  • No Cardiovascular death of more than one parent before age 60
  • No tobacco use in last 12-24 months (varies by company)
  • Cholesterol under 285
  • No substance abuse in past 7 years
  • No hazardous activities
  
  • Some health impairments
  • May have currently controlled blood pressure
  • No cardiovascular death of a parent before age 61
  • No tobacco use in last 12 months (varies by company)
  • Cholesterol under 300
  • no substance abuse in past 7 years
  • No hazardous activities

 

Additional Information/Privacy Policy

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