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Do you currently have a life insurance policy?


What is the amount of coverage of your current policy?


How much coverage would you like us to quote? It's OK to estimate.


Have you ever used any tobacco or nicotine products?

Even if you smoke or recently quit, our agents may be able to find you low rates.


Have you received any driving violations, besides parking tickets, in the past five years?


Do you currently engage in any of these sports or activities?

  • Piloting aircraft
  • Bungee jumping
  • Mountain & rock climbing
  • Scuba diving
  • Scuba diving
  • Skydiving

Have you ever been treated for any of the below? Even if you have less than perfect health, our agents may be able to find affordable rates. (Check all that apply.)


Did your parents and/or siblings have any incidents of heart disease, cancer, stroke or diabetes before the age of 65?

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Your plan could vary depending on your age, health, issuing company and other factors. Not available in all states. * Best’s Credit Ratings™ are under continuous review and subject to change and/or affirmation. For the latest Best’s Credit Ratings™ and Best’s Credit Reports (which include Best’s Credit Ratings™), visit the A.M. Best website at See Guide to Best’s Credit Ratings™ for explanation of use and charges.” “Best’s Credit Ratings™ reproduced herein appear under license from A.M. Best and do not constitute, either expressly or impliedly, an endorsement of Med Care Plus or its recommendations, formulas, criteria or comparisons to any other ratings, rating scales or rating organizations which are published or referenced herein. A.M. Best is not responsible for transcription errors made in presenting Best’s Credit Ratings™. Best’s Credit Ratings™ are proprietary and may not be reproduced or distributed without the express written permission of A.M. Best Company.” A Best’s Financial Strength Rating opinion addresses the relative ability of an insurer to meet its ongoing insurance obligations. It is not a warranty of a company’s financial strength and ability to meet its obligations to policyholders. View our Important Notice: Best’s Credit Ratings for a disclaimer notice and complete details at

AIG Companies policies issued by American General Life Insurance Company (AGL). Issuing company AGL is responsible for financial obligations of insurance products and is a member of American International Group, Inc. (AIG).

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.