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Quotes Insurance Quotation System
Welcome!!!
Administered by
DWF Association Health Programs
12721 Metcalf Avenue, Suite 100
Overland Park, KS 66213
Toll Free Phone: (888) 450-3040
help@associationpros.com
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Life Insurance
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About Us
Request For Long Term Care Quote
(
more info..
)
Personal Details
First Name
*
Last Name
*
Gender
*
Male
Female
Date of Birth
*
Select
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
/
Select
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Select
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
Height
0'
3'
4'
5'
6'
7'
Feet
0"
1"
2"
3"
4"
5"
6"
7"
8"
9"
10"
11"
Inch
Weight
Lbs
Do you use tobacco?
Yes
No
Spouse Coverage Desired?
Yes
No
Spouse Details
First Name
Last Name
Date of Birth
Select
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
/
Select
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Select
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
Height
0'
3'
4'
5'
6'
7'
Feet
0"
1"
2"
3"
4"
5"
6"
7"
8"
9"
10"
11"
Inch
Weight
Lbs
Do you use tobacco?
Yes
No
Contact Details
Street
City
State
*
Select State
ALASKA
ALABAMA
ARKANSAS
ARIZONA
CALIFORNIA
COLORADO
CONNECTICUT
DISTRICT OF COLUMBIA
DELAWARE
FLORIDA
GEORGIA
HAWAII
IOWA
IDAHO
ILLINOIS
INDIANA
KANSAS
KENTUCKY
LOUISIANA
MASSACHUSETTS
MARYLAND
MAINE
MICHIGAN
MINNESOTA
MISSOURI
MISSISSIPPI
MONTANA
NORTH CAROLINA
NORTH DAKOTA
NEBRASKA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEVADA
NEW YORK
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VIRGINIA
VERMONT
WASHINGTON
WISCONSIN
WEST VIRGINIA
WYOMING
ZipCode
Day Phone
*
Mobile Phone
E-Mail
*
Other Details
List any major conditions, if any that you and/or your spouse/partner have or have had in the past 10 years.
List any medications that you and/or your spouse/partner are currently using. Please include frequency and dosage if possible.
Do you or your spouse/partner currently have a Long Term Care policy?
Yes
No
If yes, with which company?
If yes, what is the major reason for your inquiry into another quote?
If you know which options you would like quoted, please complete the information below, otherwise click "submit" below.
Daily Benefit
Select
$100
$110
$120
$130
$140
$150
$160
$170
$180
$190
$200
$210
$220
$230
$240
$250
$260
$270
$280
$290
$300
$310
$320
$330
$340
$350
$360
$370
$380
$390
$400
Benefit Period
Select
2 years
3 years
4 years
5 years
6 years
7 years
10 years
Unlimited
Elimination Period
Select
0 Days
30 Days
60 Days
90 Days
180 Days
Home Care Benefit
Yes
No
Not Sure
Inflation Protection
Yes
No
Not Sure
Return of Premium
Yes
No
Not Sure
Survivorship Benefit
Yes
No
Not Sure
Non-forfeiture Option
Yes
No
Not Sure
*
Mandatory field
Product not available in all states
FAQs
|
Licensing,Disclaimer&Privacy Policy
A 2 year contestable and suicide provision applies on Life insurance contracts in most states. See product details for form number.
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