Must be at least 18 years old.
Please enter a whole dollar amount between $100,000 and $20,000,000 (numbers only - no commas or decimals).
Applicant must meet the Preferred Nontobacco criteria, be able to truthfully answer "no" to all of the questions below, and not exceed the weight on the chart for their height.
- Have you used any form of nicotine in the past 36 months?
- Have you participated in any hazardous sport activities or aviation in the past five years?
- Have you been charged with or convicted of a DWI or DUI within the past ten years?
- Have you ever sought or received treatment for alcohol and/or drug abuse?
- Has a member of your immediate family died from or been diagnosed with coronary artery disease, cerebral vascular disease, diabetes or cancer* prior to age 60?
- Does your total cholesterol exceed 225 and total cholesterol/ HDL ratio exceed 5?
- Have you experienced significant hypertension in the past, or are current blood pressure readings higher than 140/85?
- Have you been charged with two moving violations within 36 months?
- Are there any abnormal ranges on your current blood panel?
| Height | Weight |
|---|
| 5'0" | 145 |
| 5'1" | 149 |
| 5'2" | 153 |
| 5'3" | 158 |
| 5'4" | 162 |
| 5'5" | 166 |
| 5'6" | 170 |
| 5'7" | 176 |
| 5'8" | 182 |
| 5'9" | 188 |
| 5'10" | 193 |
| 5'11" | 199 |
| 6'0" | 205 |
| 6'1" | 211 |
| 6'2" | 216 |
| 6'3" | 222 |
| 6'4" | 227 |
| 6'5" | 233 |
| 6'6" | 238 |
| 6'7" | 243 |
| 6'8" | 249 |
| 6'9" | 254 |
| 6'10" | 260 |
| 6'11" | 265 |
* Excludes gender-specific cancers for applicants that are a different gender than the family member.
If the proposed insured answers "yes" to any of the following questions, he/she may not be eligible for the Preferred Nontobacco classification. Submit a written explanation outlining details of any "yes" answer to your underwriter. If all answers are "no" and the evidence of insurability submitted with the application is favorable, the policy will be issued as Preferred Nontobacco.
- Have you used any form of nicotine in the past 24 months? (exception: no more than two cigars per year)
- Have you participated in any hazardous sport activities or aviation in the past 24 months?
- Are you a private pilot with fewer than 500 solo hours; or do you fly more than 250 hours per year; or do you fly in something other than conventional aircraft (jet/prop)?
- Have you been charged with two or more moving violations within 24 months?
- Have you been convicted of driving under the influence of alcohol or any other drug within the past five years?
- Have you sought or received treatment for alcohol or drug abuse within the past ten years?
- Has a member of your immediate family died of coronary artery disease, cerebral vascular disease, diabetes or cancer* prior to age 60?
- Does your weight exceed the maximum limit for your height according to the accompanying height and weight chart?
-
Based on your age, does your total cholesterol exceed the following limits?
| Age | Cholesterol mg/dl |
|---|
| 20 - 40 | 230 |
| 41 - 55 | 250 |
| 56 - up | 270 |
- Does your total cholesterol/HDL ratio exceed 5.5?
- Is your blood pressure higher than 140/85? (If over age 55, 150/90?)
- Have you been convicted of a felony in the past five years?
| Height | Weight |
|---|
| 5'0" | 154 |
| 5'1" | 159 |
| 5'2" | 164 |
| 5'3" | 169 |
| 5'4" | 175 |
| 5'5" | 180 |
| 5'6" | 186 |
| 5'7" | 192 |
| 5'8" | 197 |
| 5'9" | 203 |
| 5'10" | 209 |
| 5'11" | 215 |
| 6'0" | 221 |
| 6'1" | 227 |
| 6'2" | 234 |
| 6'3" | 240 |
| 6'4" | 246 |
| 6'5" | 253 |
| 6'6" | 260 |
| 6'7" | 266 |
| 6'8" | 273 |
| 6'9" | 280 |
| 6'10" | 287 |
| 6'11" | 294 |
* Excludes gender-specific cancers for applicants that are a different gender than the family member.
If the proposed insured answers "yes" to any of the following questions, he/she may not be eligible for the Select Nontobacco classification. Submit a written explanation outlining details of any "yes" answer to your underwriter. If all answers are "no" and the evidence of insurability submitted with the application is favorable, the policy will be issued as Select Nontobacco.
- Have you used any form of nicotine in the past 12 months? The only exception is the occasional celebratory cigar (not more than six cigars per year) with a negative HOS for nicotine finding.
- Are you a private pilot with fewer than 350 solo hours; or do you fly more than 250 hours per year; or do you fly in something other than conventional aircraft (jet/prop)?
- Have you been charged with three or more moving violations within 24 months or have you been convicted of driving under the influence of alcohol or any other drug within the past three years?
- Have you sought or received treatment for alcohol or drug abuse within the past eight years?
- Has a member of your immediate family died of coronary artery disease, cerebral vascular disease, diabetes or cancer* prior to age 60?
- Does your weight exceed the maximum limit for your height according to the accompanying height and weight chart?
-
Based on your age, does your total cholesterol exceed the following limits?
| Age | Cholesterol mg/dl |
|---|
| 20 - 40 | 245 |
| 41 - 55 | 265 |
| 56 - up | 285 |
- Does your total cholesterol/HDL ratio exceed 6.5?
- Is your blood pressure higher than 150/90?
| Height | Weight |
|---|
| 5'0" | 164 |
| 5'1" | 169 |
| 5'2" | 174 |
| 5'3" | 179 |
| 5'4" | 185 |
| 5'5" | 190 |
| 5'6" | 196 |
| 5'7" | 202 |
| 5'8" | 207 |
| 5'9" | 213 |
| 5'10" | 220 |
| 5'11" | 225 |
| 6'0" | 232 |
| 6'1" | 239 |
| 6'2" | 245 |
| 6'3" | 252 |
| 6'4" | 259 |
| 6'5" | 266 |
| 6'6" | 273 |
| 6'7" | 280 |
| 6'8" | 287 |
| 6'9" | 294 |
| 6'10" | 301 |
| 6'11" | 309 |
* Excludes gender-specific cancers for applicants that are a different gender than the family member.
Standard Nontobacco rates are available to those individuals ages 18-85 who have not used any form of nicotine for the past 12 months (exception: no more than two cigars/month) and do not exceed the maximum weight for their height on the accompanying chart.
| Height | Weight |
|---|
| 5'0" | 184 |
| 5'1" | 191 |
| 5'2" | 197 |
| 5'3" | 203 |
| 5'4" | 210 |
| 5'5" | 216 |
| 5'6" | 223 |
| 5'7" | 230 |
| 5'8" | 237 |
| 5'9" | 244 |
| 5'10" | 251 |
| 5'11" | 258 |
| 6'0" | 265 |
| 6'1" | 273 |
| 6'2" | 280 |
| 6'3" | 288 |
| 6'4" | 296 |
| 6'5" | 304 |
| 6'6" | 312 |
| 6'7" | 320 |
| 6'8" | 328 |
| 6'9" | 336 |
| 6'10" | 344 |
| 6'11" | 352 |
Preferred Tobacco rates are available to those individuals ages 18-80 who meet all of the qualifications for the Preferred Nontobacco and Select Nontobacco classifications, except they have used some form of nicotine in the past 24 months.
Standard Tobacco rates are available to those individuals ages 18-85 who do not exceed the maximum weight for their height on the accompanying chart, and have used nicotine in the past 12 months.
| Height | Weight |
|---|
| 5'0" | 184 |
| 5'1" | 191 |
| 5'2" | 197 |
| 5'3" | 203 |
| 5'4" | 210 |
| 5'5" | 216 |
| 5'6" | 223 |
| 5'7" | 230 |
| 5'8" | 237 |
| 5'9" | 244 |
| 5'10" | 251 |
| 5'11" | 258 |
| 6'0" | 265 |
| 6'1" | 273 |
| 6'2" | 280 |
| 6'3" | 288 |
| 6'4" | 296 |
| 6'5" | 304 |
| 6'6" | 312 |
| 6'7" | 320 |
| 6'8" | 328 |
| 6'9" | 336 |
| 6'10" | 344 |
| 6'11" | 352 |
