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General Information:

Please fill in the general information...then below fill in information for desired product.

We will make a recommendation for a specific company based on the information you provide to us. The final rating your client gets will be ultimately decided by the insurance company you apply.

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Monthly  Quarterly  Semi-Annual  Annual
Yes  No  || Yes  No 
 || 
 || 
       
Health Conditions & Medication? - please be as specific as you can. The more info you provide - including medical records or pathology reports, the more accurately we can pre-underwrite your case:

Yes  || Yes 

  Individual Health Insurance
Great West Other
Co-pay Plan     Health Savings Account 
  Long Term Care
2 Years 3 Years 4 Years 5 Years LifeTime
30 days  60 days  90 days  180 days  365days
lifetime  10 pay  20 pay 
1. Simple interest.
2. Compound interest.
3. Return of premium.
4. Home and Community Care benefits.
5. Indemnity benefits.
6. *Dual waiver of premiums.
(*Included with some plans, a rider on others)
  Life Insurance
TERM  10  15  20  30
   
Universal
Equity Indexed
Final Expense
Juvenile
Guaranteed to 100
       
1. Waiver of premium for disability.
2. Spousal rider.
3. Children's rider.
4. Accelerated Death Benefit.
5. Guaranteed insurability rider.
6. Disability rider.
7. Return of premium.
   Assurity Disability Income Insurance
       
       
       
male  female 
yes  no 
1yr. 2yrs. 5yrs. 65yrs
Class  IND
 BOE
 MDI
SA  M
       
Optional Benefit Riders
       

Supplemental Income Rider
Available only at time of app.
dollar-for-dollar social insurance
offset if social insurance is paid.

Yes No

Non-Cancelable Rider
(4 & 3A to standard risk)
When non-can rider added
to 1-2-5 year benefit periods.
Policy becomes non-can to age 65.
(Not available for "to age 65"
benefit period)

Yes  No

5 Year Own Occupation Rider
(4 & 3A & for 5 year & to age 65
benefit). Extends own occupation
definition from 2 year to 5 year
at an additional cost.

Yes  No

Hospital Event Rider (all classes)
Monthly benefit must equal
monthly benefit under the
base policy. Pays hospital
benefit for each month of
confinement up to 6 months
for an injury or sickness.

Yes  No

Guaranteed Insurability Rider
(All classes-standard risk)
Maximum issue age is 37
Minimum amount = 2 units
Maximum amount = 5 units
Units must equal the number
of hundreds of base policy subject
to max units. Enables coverage
to increase by a non-disables
insured at 25, 28, 34, 37, 40
regardless of occupation.

Yes  No

Automatic Benefit Increase Rider
(All Classes)
Annual increase equal to 5% of
monthly benefit, subject to
contract provisions. Lifetime
cap on monthly benefit is 2
times original base.

Yes  No

Residual Benefit Rider
2A, 3A, 4A, ONLY
All benefit periods
Residual replaces partial benefit
Under a Dr's care
At least 25% loss of prior Earnings.

Yes  No

Return Of Premium
(All classes and benefit periods)
Return of all premiums received,
minus any benefits paid or
premiums waived.
After 3rd policy year
Policy is surrendered upon
payment of rider.
18-44 after 25 years, 100%
45-65 after 10 years, 50%

Yes  No

Catastrophic Disability Income Rider
Not to be available is all states
Ages 18-55: 1,2, and 5-year base
policy benefit periods and all
CDIR benefit periods.
Ages 56-60: 1 and 2 yr. Base policy
benefit periods and for 3 and 4yr
CDIR benefit periods to extend
the total benefit period payable
under the base policy to 5 years.

Yes  No
For more information on any of the products above ...contact Josh Youngs at tel#: 303.996.5264 fax#: 303.996.6224, or contact by email.
 

 

 

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