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LifeInsure Rate Class Health Quiz

Discover Enormous Savings on Your Life Insurance Policy!

Different carriers have unique underwriting niches. We find you the best rate classification, resulting in thousands of dollars in savings over the life of your policy. Our process ensures you get the best option in minutes!

Take the Health Quiz Below and Receive a Pre-Approval Email in Minutes!

**This information is NOT shared, and is used specifically to isolate proper rate class which will determine YOUR price and best insurance provider!

LifeInsure Rate Class Health Quiz

“*” indicates required fields

Legal Name*

First

Last

Gender*

MaleFemale

State*

Email*

Phone Number*

Date of Birth*

MM slash DD slash YYYY

Smoking/Tobacco Use*

NoYes – CurrentlyQuit 1 Year AgoQuit 2 Years AgoQuit 3 Years AgoQuit 4 Years AgoQuit 5 (or more) Years Ago

Marijuana Use*

NoMedicalRecreationalBoth

If Yes to Marijuana – How many times per month

Height*

4’8″4’9″4’10″4’11″5’0″5’1″5’2″5’3″5’4″5’5″5’6″5’7″5’8″5’9″5/10″5’11″6’0″6’1″6’2″6’3″6’4″6’5″6’6″6’7″6’8″6’9″6’10″6’11″7’0″

Weight*

Have you lost more than 10 lbs in the last 12 months?*

NoYes

If Yes to above question, how much did you lose?

Any treatment for high blood pressure?*

NoYes

Any treatment for elevated cholesterol?*

NoYes

Heart problems or irregular heart beat?*

NoYes

History of stroke, mini stroke or blood clots?*

NoYes

History of Diabetes or elevated blood sugar?*

I don’t have DiabetesType 1Type 2Elevated Blood Sugar

If Yes to Diabetes, your last a1c reading (if known)

If Yes to Diabetes, any teatment?

NoLifestyle ChangesOral MedsInsulin

Any rorm of cancer or tumor?*

NoYes

Details, if Yes to cancer or tumors

Any ussues with Asthma or respiratory ailments?*

NoYes

Details, if Yes to Ashtma or respiratory ailments

Sleep Apnea?*

NoYes

If Yes to Sleep Apnea, do you use a Cpap Machine?

NoYes

Diagnosed with Anxiety or Depression?*

NoYes

If Yes to Anxiety or Depression, current treatment (including medications)?

History of Alcohol or Drug Abuse*

NoYes

If Yes to Alchohol or Drug Abuse, date oflast treatment?

MM slash DD slash YYYY

Any Issues with the Liver or Kidneys?*

NoYes

List Current Medications

Any Immediate Family Deaths prior to age 65?*

NoHeart DiseaseCancerStrokeDiabetes

Driving History – any moving violations in last 5 Yyars?*

NoYes

Driving History – any DUIs or Reckless Driving?*

NoYes

US Citizen?*

YesPermanent Resident – Green CardVisaUndocumented with ITIN NumberUndocumented – No ITIN Number

Do you have any intention to live outside the US in the next 2 years?

NoYes

Active Duty in the Military or Military Reserves?*

NoYes

Life Insurance Ever Been Rated, Canceled, Postponed or Declined?*

NoYes

Any life insurance applications pending with any other company?*

NoYes

Have you ever declared bankruptcy?*

NoYes, Chapter 7Yes, Chapter 13

Have you ever been convicted of a misdemeanor?*

NoYes

Have you ever been convicted of a felony?*

NoYes

How much life insurance do you need (death benefit)?*

Term Length*

10 Year Term15 Year Term20 Year Term25 Year Term30 Year Term35 Year Term40 Year TermGuaranteed Universal Life (Lifetime Coverage)Whole Life

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<p>The post Rate Class Health Quiz first appeared on Lifeinsure.com.</p>

Rate Class Health Quiz

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LifeInsure Rate Class Health Quiz

LifeInsure Rate Class Health Quiz

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Rate Class Health Quiz

Call us at (866) 868-0099

LifeInsure Rate Class Health Quiz

LifeInsure Rate Class Health Quiz

Recent Posts

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Call us at
(866) 868-0099