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Note: We are NOT United Home Life Insurance Company. We are an independent insurance agency that offers their life policies.
Applying for guaranteed issue life insurance is really quite simple. Following are the questions required in most states by United Home Life Insurance Company, one of our preferred virtually guaranteed issue life insurance carriers.
This questionnaire actually allows you to answer questions for guaranteed issue life insurance and to progress to additional questions that may qualify you for a lower premium simplified issue life insurance policy.
See the policy differences or Request an Application Now.
| SECTION I - EXPRESS ISSUE WHOLE LIFE – COMPLETE SECTION I ONLY
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| A.
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Do you currently receive kidney dialysis or require oxygen use or have you been diagnosed as having a terminal illness? (Terminal illness is defined as any illness diagnosed that would reasonably be expected to cause death within twenty-four
(24) months.)
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| B.
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Do you require assistance to eat, bathe, dress or take your own medication or are you currently confined to a hospital, nursing home, mental facility or Hospice or have you been hospitalized two or more times in the past twelve months?
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| C.
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Have you ever tested positive for the AIDS virus or been diagnosed or treated, or recommended for treatment for AIDS
(Acquired Immune Deficiency Syndrome), ARC (AIDS Related Complex) or any other immune disorder?
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Any question answered “Yes” in this section will disqualify the applicant for the Express Issue Whole Life Policy.
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| SECTION II - EXPRESS ISSUE DELUXE – COMPLETE SECTIONS I & II ONLY
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| A.
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In the past 5 years, have you been diagnosed or treated for, or are you currently under treatment for: Alzheimer’s Disease, any form of Cancer (other than Basal Cell skin cancer), Heart or Circulatory Disorder (except controlled hypertension), Sickle Cell Anemia, Stroke, Kidney Disease (including dialysis), Liver Disease, any Lung Disease (except mild asthma not requiring daily medication), ALS (Lou Gehrigs Disease) or other neurological disorders (except for controlled seizure disorder with no seizures in the past 2 years), or surgery for any Heart or Circulatory Disorder (except varicose veins) or transplant of any organ?
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| B.
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Are you currently disabled or been disabled in the last six months, or at any time during the last six months been unable to mentally or physically complete 30 hours per week of active employment or have you been declined or postponed for Life or Health Insurance in the past two years?
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| C.
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In the past 10 years have you been convicted of a felony; or in the past 5 years have you been treated for, been advised to have treatment for or excessively used alcohol or any drugs of abuse?
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Any question answered “Yes” in this section will disqualify the applicant for the Express Issue Deluxe Policy.
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| SECTION III - EXPRESS ISSUE PREMIER – COMPLETE SECTIONS I, II & III
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| A.
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In the past 5 years, have you been diagnosed or treated for, or are you currently under treatment for: Schizophrenia, Bipolar
Disorder, Diabetes requiring insulin treatment, SLE (Systemic Lupus Erythematosus)?
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| B.
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In the past 5 years, have you been convicted of operating a vehicle while intoxicated, or had your drivers license suspended or revoked?
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| C.
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Do you now participate in, or do you have plans to participate in any hazardous sport or aviation?
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Any question answered “Yes” in this section will disqualify the applicant for the Express Issue Premier Policy.
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| Note: Policies mentioned above are not available in all states. Please check with us for availability in your state. |
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Licensed to sell guaranteed issue life insurance in:
Ohio License #104233, California License #0C94325, Florida License #D072714
Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin |
