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Disability Insurance
Life Insurance
2021 Guide to Disability Insurance
Beginner's Guide to Disability Insurance Chapter 1
Beginner's Guide to Disability Insurance Chapter 2
Beginner's Guide to Disability Insurance Chapter 3
Beginner's Guide to Disability Insurance Chapter 4
Beginner's Guide to Disability Insurance Chapter 5
Beginner's Guide to Disability Insurance Chapter 6
Beginner's Guide to Disability Insurance Chapter 7
Beginner's Guide to Disability Insurance Chapter 8
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Career
Health
Basics
What is your occupation status currently?
Select
Medical student
Resident
Fellowship
Attending
Non-physician
Medical School Program Sponsor/Institution
Medical School End Date
current annual income
Are you starting residency soon?
Yes
No
Resident Program Sponsor Institution
resident program sponsor institution
Residency end date
current annual income
Are you starting fellowship soon?
Yes
No
Fellowship Program Sponsor Institution
have you signed an employment contract yet?
Yes
No
New employers name
expected start date
expected annual income
new employer state
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Alabama
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District of Columbia
Florida
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Ohio
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Mississippi
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
This will help us get you the more accurate and affordable quotes from the big 6 companies
will you be covered by employer group disability insurance?
Yes
Not Sure
No
What is the maximum monthly benefit amount?
What percentage of your income does it cover?
Select
40%
45%
50%
55%
60%
Does your employer pay the premiums?
Yes
No
Fellowship Program/Institution
fellowship end date
current annual income
have you signed an employment contract yet?
Yes
No
New employers name
expected start date
expected annual income
new employer state
Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
This will help us get you the more accurate and affordable quotes from the big 6 companies
will you be covered by employer group disability insurance?
Yes
Not Sure
No
What is the maximum monthly benefit amount?
What percentage of your income does it cover?
Select
40%
45%
50%
55%
60%
Does your employer pay the premiums?
Yes
No
employer name
current annual income
Did you finish training in the last 12 months?
Yes
No
Training program graduation date
what was the name of your program or institution?
Please Provide Your Primary Occupational Duties
Duty
Percentage of Time Spent
Select
10
20
30
40
50
60
70
80
90
100
Select
10
20
30
40
50
60
70
80
90
100
- Remove duty
+ Add another duty
Are you covered by employer group disability insurance?
Yes
Not Sure
No
What is the maximum monthly benefit amount?
What percentage of your income does it cover?
Select
40%
45%
50%
55%
60%
Does your employer pay the premiums?
Yes
No
Are you changing employers soon?
Yes
No
New employers name
expected start date
expected annual income
new employer state
Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
This will help us get you the more accurate and affordable quotes from the big 6 companies
will you be covered by employer group disability insurance?
Yes
Not Sure
No
What is the maximum monthly benefit amount?
What percentage of your income does it cover?
Select
40%
45%
50%
55%
60%
Does your employer pay the premiums?
Yes
No
Next
Height
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4ft 0in
4ft 1in
4ft 2in
4ft 3in
4ft 4in
4ft 5in
4ft 6in
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4ft 8in
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4ft 11in
5ft 0in
5ft 1in
5ft 2in
5ft 3in
5ft 4in
5ft 5in
5ft 6in
5ft 7in
5ft 8in
5ft 9in
5ft 10in
5ft 11in
6ft 0in
6ft 1in
6ft 2in
6ft 3in
6ft 4in
6ft 5in
6ft 6in
6ft 7in
6ft 8in
6ft 9in
6ft 10in
6ft 11in
7ft 0in
7ft 1in
7ft 2in
7ft 3in
7ft 4in
7ft 5in
7ft 6in
7ft 7in
7ft 8in
7ft 9in
7ft 10in
7ft 11in
Weight
do you currently have any medical conditions?
Yes
No
List all medical conditions with dates and treatments
do you currently take any medication?
Yes
No
please provide the name, dosage, and purpose
Any recent hospitalizations or surgeries?
Yes
No
list all including dates, treatments, and outcomes
Next
first name
last name
Date of Birth
Email
Phone number
gender
Male
Female
State of Residence
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
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Iowa
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Kentucky
Louisiana
Maine
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
specialty
Select
Other
Allergy
Allergy: Immunology
Anesthesiology
Anesthesiology: Pain Management
Anesthesiology: Pediatric
Cardiology: Electrophysiology
Cardiology: Invasive
Cardiology: Invasive-Interventional
Cardiology: Noninvasive
Critical Care: Intensivist
CRNA
Dentistry: General
Dentistry: Endodontics
Dentistry: Pediatric
Dentistry: Prosthodontics
Dentistry: Periodontics
Dentistry: Orthodontics
Dermatology
Dermatology: Dermatopathology
Dermatology: Mohs Surgery
Emergency Medicine
Endocrinology/Metabolism
Family Medicine (with OB)
Family Medicine (without OB)
Family Medicine: Ambulatory Only (No Inpatient Work)
Family Medicine: Sports Medicine
Gastroenterology
Gastroenterology: Hepatology
Geriatrics
Hematology/Oncology
Hematology/Oncology: Oncology (Only)
Hospice/Palliative Care
Hospitalist: Family Medicine
Hospitalist: Internal Medicine
Hospitalist: IM-Pediatric
Hospitalist: OB/GYN
Hospitalist: Pediatric
Infectious Disease
Internal Medicine: General
Internal Medicine: Ambulatory Only (No Inpatient Work)
Internal Medicine: Pediatric
Neonatology
Nephrology
Neurology
Nurse
Nurse Practitioner
Obstetrics/Gynecology: General
OB/GYN: Gynecology (Only)
OB/GYN: Gynecological Oncology
OB/GYN: Maternal & Fetal Med
OB/GYN: Reproductive Endocrinology
OB/GYN: Urogynecology
Occupational Medicine
Ophthalmology
Ophthalmology: Corneal & Ref Surgery
Ophthalmology: Pediatric
Ophthalmology: Retina
Orthopedic (Nonsurgical)
Orthopedic Surgery: General
Orthopedic Surgery: Foot & Ankle
Orthopedic Surgery: Hand
Orthopedic Surgery: Hip & Joint
Orthopedic Surgery: Pediatric
Orthopedic Surgery: Spine
Orthopedic Surgery: Trauma
Orthopedic Surgery: Sports Medicine
Otolaryngology
Otorhinolaryngology
Otorhinolaryngology: Pediatric
Pain Management: Nonanesthesia
Pathology: Anatomic & Clinical
Pathology: Anatomic
Pathology: Clinical
Pediatrics: General
Pediatrics: Adolescent Medicine
Pediatrics: Allergy/Immunology
Pediatrics: Cardiology
Pediatrics: Child Development
Pediatrics: Critical Care/Intensivist
Pediatrics: Emergency Medicine
Pediatrics: Endocrinology
Pediatrics: Gastroenterology
Pediatrics: Genetics
Pediatrics: Hematology/Oncology
Pediatrics: Infectious Disease
Pediatrics: Neonatal Medicine
Pediatrics: Nephrology
Pediatrics: Neurology
Pediatrics: Pulmonology
Pediatrics: Radiology
Pediatrics: Urgent Care
Pharmacist
Physician Assistant
Physiatry (Physical Medicine & Rehabilitation)
Physical Therapy
Podiatry: General
Podiatry: Surgery-Foot & Ankle
Psychiatry: General
Psychiatry: Child & Adolescent
Psychiatry: Geriatric
Pulmonary Medicine: General
Pulmonary Medicine: Critical Care
Pulmonary Medicine: General & Critical Care
Radiation Oncology
Radiology: Interventional
Radiology: Diagnostic
Radiology: Neurological
Radiology: Nuclear Medicine
Rheumatology
Sleep Medicine
Surgery: General
Surgery: Bariatric
Surgery: Breast
Surgery: Cardiovascular
Surgery: Cardiovascular-Pediatric
Surgery: Colon & Rectal
Surgery: Neurological
Surgery: Neurological-Pediatric
Surgery: Oncology
Surgery: Oral
Surgery: Pediatric
Surgery: Plastic & Reconstruction
Surgery: Thoracic (Primary)
Surgery: Transplant
Surgery: Trauma
Surgery: Vascular (Primary)
Urgent Care
Urology
Urology: Pediatric
Please provide other specialty
citizenship status
US Citizen
Permanent US Resident
Foreign Citizen
in which country are you a citizen?
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Afghanistan
Akrotiri
Albania
Algeria
American Samoa
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Angola
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Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Ashmore and Cartier Islands
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Bassas da India
Belarus
Belgium
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Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
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British Indian Ocean Territory
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Chad
Chile
China
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Congo, Republic of the
Cook Islands
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Dominican Republic
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Faroe Islands
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Finland
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French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia, The
Gaza Strip
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Germany
Ghana
Gibraltar
Glorioso Islands
Greece
Greenland
Grenada
Guadeloupe
Guam
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Guinea-Bissau
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Heard Island and McDonald Islands
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Navassa Island
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Tromelin Island
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Venezuela
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Virgin Islands
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West Bank
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What type of Visa/Green card do you have?
J-1
H-1B
O-1
F-1
L-1
Are you active duty military?
Yes
No
current discharge date
how did you hear about us?
What is their name?
Are you interested in life insurance?
Yes
No
any additional comments or questions?
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