Q-Cubed Insurance Services
About ten minutes. Anything you're unsure of can be left blank, and there are no wrong answers.
This page does not send anything anywhere. It has no connection to any server. When you press the button it builds a block of text and copies it to your clipboard; you paste it into an email and send it. Nothing leaves your device until you do.
Please do not include your Social Security number, date of birth, policy numbers or bank details. We don't need any of them, and anything that arrives is deleted automatically before your answers are read.
So we can reach out and go through your options with you. Your contact details are only used to get in touch - they have no effect on the price you are quoted or which policies you qualify for.
We need at least one of these - a phone number or an email - so we can get back to you.
So we call at a time that actually suits you.
Only if somebody did. I would like to thank them.
Your state, your age and tobacco use decide which insurers can consider you at all, so these three matter more than anything else on the form.
IF THE POLICY IS ON SOMEONE ELSE, answer the rest of this form about THAT person - their age, their health, their tobacco use - because that is who the insurer looks at. You would be the one paying and the one arranging it.
We are licensed in Illinois today, with New York and Virginia pending. If your state is not one of those, say so anyway - we can apply for a license in any state, and it is usually a short wait rather than a no.
Your age at your last birthday. Please don't send a date of birth - we don't need it and we don't store it.
The month only - never the date. Some insurers price on your age at your nearest birthday, so the month alone can move you a whole year in their eyes. We work that out; you don't have to.
Insurers publish two separate price tables, one for men and one for women, and we have to quote you against one of them. That is the only thing this answer is used for.
Includes cigarettes, cigars, vaping, patches, gum and chew.
What the money is for, and roughly how much of it. If you have no idea what amount you need, skip it - the budget question in the next section is the easier one, and there is no wrong answer to it.
Most people have more than one reason - check all that apply. Unless an option says otherwise, it means money paid to your beneficiaries - the people you choose to receive it - after you die.
If you checked more than one reason, which could you least do without?
Answer this or the monthly budget below. Both is best. If you have no idea what amount you need, leave this blank and give a budget instead - that is usually the easier question to answer.
If this is for a funeral and final expenses, pick the first one - that coverage needs to be there whenever it happens, however long that is. The others are for coverage meant to run out once a particular need has passed.
Some policies fix the price and the payout for life. Others can move.
Say no if the whole point is what it leaves behind. That answer usually buys far more coverage for the same money.
Answer this or the coverage amount above. Both is best - it lets us show what you asked for and what your budget actually reaches.
Insurers publish height and weight limits, condition lists and medication lists, and they do decline on them. Being accurate here means you are only shown policies you can actually be issued.
Insurers publish height and weight limits and do decline outside them, so this changes which policies you can be issued.
Check anything that applies. These are the conditions insurers price differently. There is no wrong answer, and being accurate means you are only shown policies you can actually be issued.
Optional. Leave this blank if nothing above was missed - we will go through your health in detail when we speak.
Start typing and pick from the list. Some insurers decline on a specific medication, so this matters more than people expect.
Insurers price a handful of activities differently, and these are the ones they ask about. Check any you do more than once in a while - and check the last box if none of them apply.
A straight decline, rather than an offer you did not take.
Sometimes called being rated. It is common, and it does not stop you being covered.
A nurse visits your home or office for about 20 minutes, takes your height, weight and blood pressure, and collects a blood and urine sample. There is no cost to you. Saying yes opens up policies that are often noticeably cheaper but take a few weeks longer to issue. Saying no keeps you to policies that are decided from your answers alone.
Insurers treat some jobs and some group memberships differently, so these can open up options that would not otherwise be available to you.
Insurers treat some occupations differently, so this can change what is available to you.
Some coverage designed around a mortgage requires you to have one.
Membership in one of these can open up coverage that is not generally available.
Coverage your employer provides or that you signed up for at work.
The insurance company, roughly how much it pays out, and roughly when you bought it. The year matters because term policies run out, and knowing when yours started tells us how long you have left. Please don't send policy numbers - we don't need them and we don't store them.
Skip this if you have no other life insurance.
This is not an application, and it doesn't put any coverage in place. Nothing is guaranteed until an insurance company issues a policy and delivers it to you. By sending this, you're giving us permission to contact you about it.