Hospital Indemnity quote

Hospital Indemnity Quote REQUEST

Welcome to the quote request page. I personally look at each quote and based on your information I will recommend the plan that makes the most sense for you and your particular situation. Once you submit the information allow me between 24 and 48 business hours to response (does not include weekend and holidays). Feel free to also contact me if you have questions.

Please Note: I am a licensed Agent in Colorado only. You must be a resident of Colorado to request a quote or information. However, I am looking into getting licenses in other states in the future. If you like what you see in my website and would like me to expand to your states, send me a request.

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Qualifications

Check if you qualify before you can request quote

Are you resident of the State of Colorado *

Is your age between 64 years and 6 months old (64 ½ years old) and 65 years and 6 months (65 ½ years old)? *

If you can answer YES, you Get Guarantee issue and does not need to answer Medical Questions

Enter how old you will be when you would like the policy to start? *

Medical Questions - If any answer to questions 1 thru 5 is Checked ("YES") you are not eligible for coverage *

1. In the past 12 months have you been confined as an inpatient to a hospital, nursing home or received home health care?
2. In the past 12 months have you had a heart attack, stroke, heart surgery/bypass, malignant melanoma or cancer (other than skin cancer)?
3. In the past 12 months have you had been treated for Chronic Obstructive Lung Disease, insulin dependent diabetes, dementia, Alzheimer’s disease, congestive heart failure, or chronic liver or kidney disease?
4. In the past 12 months have you had surgery which required an inpatient hospital stay or been advised to have surgery which will require an in-patient stay but have not yet done so?
5. Have you ever been treated for or been diagnosed by a member of the medical profession as having Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or HIV infection?
None of the above conditions apply to me.

Do you want a quote for Monthly payments or Quarterly payments? *

Monthly - You must pay using automatic bank withdraw from a checking or savings account.
Quarterly - The company can send you a bill and you can pay by check or money order.

What daily hospital confinement amount would you like to buy? *

I would like the same as my current plan - I understand that my current plan can change this amount every year.
I would to enter the amount.

Enter the amounts of daily hospital confinement you want a quote. You can buy from a minimum of $100 to a maximum of $600 per day rounded to the nearest $10 dollars (ex. $100, $110, $120, etc.). *

In addition to DAILY HOSPITAL CONFINEMENT quote, are you interested in additional riders quote (Cancer, Ambulance, Outpatient Surgery and/or Skilled Nursing Facility)? *

What other riders are you interested to receive a quote? *

CANCER
OUTPATIENT SURGERY
AMBULANCE TRIPS
SKILLED NURSING FACILITY

Additional Medical Questions for Cancer - If question 6 or 7 is Checked (“YES”), you are not eligible for the Cancer Rider *

6. In the past 10 years, have you had, been diagnosed as having, received medication for, or been treated by a medical practitioner for leukemia, Hodgkin’s or Non-Hodgkin’s disease, malignant melanoma, sarcoma or any other internal cancer or had radiation or chemotherapy for any of these conditions?
7. In the past 24 months, have you been advised to seek treatment or medical advice from a medical practitioner, or had experienced any symptoms that would have caused an ordinarily prudent person to seek medical advice for any of the medical conditions listed in question #6?
None of the above apply to me.

What amount of Lump Sum Cancer Benefit do you wish to get a quote? *

$2,500
$5,000
$7,500
$10,000

What amount of Outpatient Surgery Benefit do you wish to get a quote? *

$250
$500
$750
$1,000

Email *

Name *

First

Last

Optional Phone

Add your questions and comments about the Hospital Indemnity Plan here:

Resident State Qualification *

Sorry, I don't have quote information for other states - Only Colorado

Under Age Qualification *

Sorry, you do not qualify because you must be at least 64 1/2 years old

Over Age Qualification *

Sorry, you do not qualify because you cannot be more than 85 years old

Medical Questions Qualification *

Sorry, you do not qualify because of the medical condition

Medical Cancer Question Qualification *

Sorry, you do not qualify for Cancer Rider - Remove check mark from CANCER to continue

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