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Disability Insurance
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The Big 5
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2023 Guide to Disability Insurance
Frequently Asked Questions
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What is your occupation status currently?
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Medical School Program Sponsor/Institution
Medical School End Date
current annual income
Are you starting residency soon?
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resident program sponsor institution
Residency end date
current annual income
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Fellowship Program Sponsor Institution
have you signed an employment contract yet?
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New employers name
expected start date
expected annual income
new employer state
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This will help us get you the more accurate and affordable quotes from the Big 5 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
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Alabama
Alaska
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California
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Ohio
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Oregon
Pennsylvania
Puerto Rico
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 5 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
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10
20
30
40
50
60
70
80
90
100
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10
20
30
40
50
60
70
80
90
100
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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
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
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 5 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
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5ft 0in
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5ft 6in
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Weight
do you currently have any medical conditions?
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List all medical conditions with dates and treatments
do you currently take any medication?
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please provide the name, dosage, and purpose
Any recent hospitalizations or surgeries?
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list all including dates, treatments, and outcomes
Next
first name
last name
Date of Birth
Email
Phone number
gender
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State of Residence
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Texas
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specialty
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Other
Allergy
Allergy: Immunology
Anesthesiology
Anesthesiology: Critical Care
Anesthesiology: Pain Management
Anesthesiology: Pediatric
Cardiology: Electrophysiology
Cardiology: Invasive
Cardiology: Invasive-Interventional
Cardiology: Noninvasive
Chiropractor
Critical Care: Intensivist
CRNA
Dentistry: General
Dentistry: Endodontics
Dentistry: Pediatric
Dentistry: Prosthodontics
Dentistry: Periodontics
Dentistry: Orthodontics
Dermatology
Dermatology: Dermatopathology
Dermatology: Invasive
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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
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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
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Nurse
Nurse Practitioner
Obstetrics/Gynecology: General
OB/GYN: Critical Care
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: Neurological (Interventional)
Radiology: Neurological (Non-Interventional)
Radiology: Nuclear Medicine
Rheumatology
Sleep Medicine
Surgery: General
Surgery: Bariatric
Surgery: Breast
Surgery: Cardiovascular
Surgery: Cardiovascular-Pediatric
Surgery: Colon & Rectal
Surgery: Critical Care
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
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in which country are you a citizen?
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Afghanistan
Akrotiri
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Gaza Strip
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What type of Visa/Green card do you have?
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H-1B
O-1
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L-1
Are you active duty military?
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No
current discharge date
how did you hear about us?
What is their name?
Are you interested in life insurance?
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any additional comments or questions?
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