Request Your Free Critical Illness Insurance Quote

Request a FREE, No-Obligation Cost Quote from a specially designated
Critical Illness Insurance Association Member.

Please fill in as much information as possible.
If you are unaware of what to choose (or prefer not to answer at this time), simply leave the area blank.
Pop-ups with helpful information will appear when you scroll over each area.

Your information will be forwarded to ONLY ONE designated professional - who we know will be best suited to help you. You've come to the best source for information and help.


  1. Your Information
  2. Design Your Plan
  3. Your Quote

1. Your Information Is Secure

Your information will be kept safe and secure and will be used only to prepare your quote.

Why a phone conversation is necessary.

Our Designated Expert Must Speak With You

We provide your information only to one designated professional. Most people interested in critical illness insurance protection have some health issues. By asking a few simple very quick questions over the phone, they can clarify your information about health and see what level of coverage and what discounts you may qualify for.

They will call you one time. You are of course never under any obligation. But without that initial phone call we are sorry that we will not be able to assist you.

Enter Your Personal Information















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To provide you with accurate information about costs and qualifications for coverage the Association's designated professional must speak with you by phone (1 time).

2. What Benefit Would You Like To Receive?

This information will help our designated provide you with the most accurate costs and options. If you are not sure what to select, leave the area blank.

How Does Your Health Information Affect Your Cost?

How can this information reduce my cost?

Insurance companies will look at your health information prior to issuing your critical illness insurance policy.

We request the following information to help us determine if you can health qualify for critical illness insurance and to make certain that you get the best (lowest) costs.

Female  Male


   


 


Female  Male


   


 


How Much Coverage Do You Want? Hover over for more info

How Much Coverage Do You Want?

Critical illness insurance costs are based on the cash benefit amount you select, your age, sex and health. You can get a good sense of costs by looking at our Cost Calculator. Click here to see rates before indicating an amount.

Consider protection equal to 2 years of mortgage (or rent) payments. Imagine the peace of mind in knowing your mortgage is covered should a critical illness strike you. Remove that stress while you focus on recovering.

$10,000
$20,000
$30,000
$40,000
$50,000
Over $50,000

$10,000
$20,000
$30,000
$40,000
$50,000
Over $50,000

Yes
No

Yes
No

Yes
No

Yes
No

Immediate family members only which includes father, mother, sister or brother.  Critical illnesses include heart attack, cancer or stroke which occurred prior to them turning age 65.

Yes
No

Yes
No




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I agree, by submitting this request that I may receive my quotes via the phone number, email and or at the address provided.