Disabilty Insurance Quote Request - Gnade Insurance Group

Disability

Step 1 of 3

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Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Date of Birth(Required)

MM slash DD slash YYYY

Gender(Required)

Male

Female

Occupation(Required)

Have you smoked within the last 12 months?(Required)

Yes

Are you self employed or the owner of your own business?(Required)

For Self-Employed individuals, the Net Annual Income is their Gross Income from their full time employment minus Business Deductions, before Personal Exemptions. For Individuals that are NOT Self-Employed, use their Gross Income from their full time employment. For any questions, please contact our Life & Health Underwriting Department.

Yes

Annual Gross Income(Required)

Gross income from employment prior to any business deductions and personal exemptions.

Annual Net Income(Required)

Net income Gross income from employment less business deductions before personal exemptions.

Do you have existing Disability coverage in force that you are not planning to replace with this policy?(Required)

Existing coverage and/or Employer offered coverage affects eligibility. Existing disability policies (not being replaced) and Employer Group coverage (even if not taken) will be deducted from the maximum monthly benefit amount available. This applies to all disability coverage with a benefit period of more than 26 weeks.

Yes

Monthly Benefit(Required)

Do you have the option to purchase additional coverage from your employer as group or individual or guaranteed purchase options?(Required)

Yes

Monthly Benefit(Required)

The base monthly benefit amount is determined by the insured's annual net income and occupational class. Additional coverage may be available by applying for the Coordinating Additional Insurance Rider. The maximum monthly benefit includes the total of the Maximum Base Benefit plus the maximum Coordinating Additional Insurance Rider, less any existing disability insurance coverage in force (not being replaced).

Quote Options

Requested Monthly Benefit(Required)

Pay Mode(Required)

Elimination Period(Required)

The elimination period is the number of days of total disability BEFORE benefits become payable. Elimination period options available are 30, 60, 90, 180 and 365 days. Choose all the options you want to see.

30 Days

60 Days

90 Days

180 Days

365 Days

Benefit Period(Required)

The benefit period is the maximum period of time for which benefits are payable per injury or occurrence. Benefit period options are 2 Years, 5 Years, and To Age 67. The policy is guaranteed renewable until age 67, as long as premiums are paid on time, regardless of benefit period. Choose all the options you want to see.

2 Years

5 Years

To Age 67

Optional Add-Ons

Individual Riders

Select rider for more info

Coordinating Additional Insurance

First Day Hospital Confined

Guaranteed Insurability

Residual Disability

Spousal Catastrophic Disability

Coordinating Additional Insurance Amount:(Required)

This rider pays a monthly benefit amount in addition to the base benefit amount. The additional benefit amount will coordinate with any disability payments you receive from Social Security, Workers Compensation and Federal, State or Local Government Retirement and Disability Funds. This means that the Coordinated Additional Insurance Benefit will be reduced by the other income received, from the sources listed above, while the insured is disabled.

First Day Hospital Confined
This rider pays a portion of the monthly benefit amount if the insured is confined to a hospital during the elimination period due to a disability. A portion of the monthly benefit amount will be paid based on the number of days that the insured is hospital confined. This benefit will waive a day of the selected elimination period for each day the insured is hospital confined.

Guaranteed Insurability
This rider allows an increase in the monthly benefit amount without proof of medical insurability other than verification that the insured is not disabled. The benefit amount can be increased every two years, subject to existing disability insurance and financial underwriting. The maximum increase amount is two times the initial monthly benefit amount.

Residual Disability Rider
This rider replaces the partial disability provision within the policy. If the insured can return to work for a portion of the time they worked prior to becoming disabled, we will pay the insured a residual disability benefit. The residual disability benefit is based on the percent of income lost as a result of the insured's total disability. This benefit will be paid if the insured suffers a loss of 15% or more of their pre-disability income and they can work no more than 80% of the time they worked in their regular occupation (or one which they are reasonably fit) prior to becoming disabled.

Spousal Catastrophic Disability

This rider provides a monthly benefit to the insured if the insured's spouse experiences a catastrophic disability. The elimination period is 60 days. The benefit will be equal to 50% of the base policy monthly benefit amount, up to $2,000. Benefits may be paid for a maximum of 24 months.

Spouse Gender(Required)

Male

Female

Spouse Date of Birth(Required)

MM slash DD slash YYYY

Spouse Hours Worked Per Week(Required)

Please enter a number from 0 to 80.

Has your spouse smoked one or more cigarettes within the last 12 months?(Required)

Yes