Living Benefits Health 1 Step 1 TYPE OF INSURANCEType Of Health InsuranceDisability Income InsuranceCritical Illness InsuranceSupplementary Health PlansGuaranteed Health Plans PROVINCEProvinceBritish ColumbiaAlbertaSaskatchewanManitobaOntarioQuebecNew BrunswickNewfoundlandNova ScotiaPrince Edward IslandYukonNorthwest TerritoriesNunavut Birth MonthBirth MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Birth DayBirth Day12345678910111213141516171819202122232425262728293031 Birth YearBirth Year193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 GenderFemaleMale Tell us about yourself so we can provide the proper quotes MONTHLY BENEFITMaximum 67% of monthly earned incomeSelect...$1,000$1,250$1,500$1,750$2,000$2,250$2,500$2,750$3,000$3,250$3,500 (popular)$3,750$4,000$4,250$4,500$4,750$5,000$5,250$5,500$5,750$6,000$6,250$6,500$6,750$7,000$7,250$7,500$7,750$8,000$8,250$8,500$8,750$9,000$9,250$9,500$9,750$10,000 HOUSEHOLD INCOMERequired to determine maximum insurable amountEstimate is okay...Up to $10,000Up to $20,000Up to $35,000Up to $50,000Up to $75,000Up to $100,000Up to $150,000Up to $250,000$250,000 and overOther BENEFIT PERIODHow long do you want your benefit to last?Select...2 years (lowest premium)5 yearsTo age 65 (highest premium) DESIRED AMOUNTWhat coverage amount are you looking for?Select...$10,000 or less$25,000$50,000$75,000$100,000 (popular)$125,000$150,000$175,000$200,000$250,000$300,000$350,000$400,000$450,000$500,000$550,000$600,000$650,000$700,000$750,000$800,000$900,000$1,000,000 or more LENGTH OF COVERAGEHow long do you want your coverage to last?Select...10 year renewable20 year renewablePay to age 65 (popular)Pay to age 75Pay lifetime COVERAGEWho is the coverage for?Select...Single (just me)CoupleFamily with childrenSingle parent COVERAGE CLASSHiger coverage class requires higher paymentSelect...Minimum (lowest cost)MediumMaximum (highest cost) DESIRED COVERAGESelect all coverages desiredDentalDrugsVisionExtended Health HEALTH CLASSWhich best describes your health history?AverageGoodExcellent TOBACCO/NICOTINE USEDo you smoke or use nicotine products?Select...No, I do not smokeYes, I am a smoker Your contact so our advisors can better assist with your quotesWe respect privacy and we do not sell your information to anyone First Name Last Name Phone Emailemail By clicking "Request Free Quotes" you grant IDC Insurance expressed written consent that we may contact you to discuss your insurance options. This does not constitute an insurance application. You are under no obligation to purchase a policy. We respect your privacy, and the information provided will never be shared with anyone. Request Free Quotes keyboard_arrow_leftPrevious Nextkeyboard_arrow_right
