Quote Me

Group LTD through Employer?

No Yes

Who Pays the premiums?

Employer Me

What are the coverage parameters?

Percent of income replacement to maximum benefit of

Individual / Association Coverage?

No Yes

Name of Insurer (if known)

What are the coverage parameters?

Monthly benefit amount

Elimination Period

Benefit Period

Additional Individual Policies?

No Yes

Name of Insurer (if known)

What are the coverage parameters?

Monthly benefit amount

Elimination Period

Benefit Period

Request for Proposal

Gender
Premium rates are partly based on gender.
Note: Female rates are higher than male rates so be sure to list the name of your Employer to see if special discounting may be available!

First Name
We don't really need to know your name ... but it is nice.
Please know that your personal information is sacred to us and will not be shared with anyone without your permission

Last Name

Birthday
Premiums rates are partly based on your age.
Most disability insurance carriers calculate premiums based on "actual age" while many Life Insurance carriers calculate premiums based on "nearest age"

State of Residence
Premiums are also based on your state of residence.

Name of Employer
Fortify has access to many special Discount Programs.
Note: very often we can offer special discounts based on Employer, Residency/Fellowship Program, Hospital, or Association.

Base Salary
Why do we ask this?
Disability Income Insurance maximum benefits are based off of income.

Bonus Income

Business Owner
As a Business Owner you may be eligible for policy upgrades based on the information provided.
Note: This is a great way to save money on this valuable protection!

Occupation
In addition to state of residence and age, premiums are also based on your current occupation.

Do you work at least 30hrs/week?
Most Disability Income policies require that you are working at least 30 hours per week but Fortify also has options for those working on a part-time basis

Do you have any inforce Disability Insurance Coverage?

Group LTD through Employer?

Individual / Association Coverage?

Additional Individual Policies?

Height
Height and weight can be a factor in the rate as Insurance carriers believe elevated weight can increase the risk of future disability.

Weight
Height and weight can be a factor in the rate as Insurance carriers believe elevated weight can increase the risk of future disability.

Do you smoke?

Notable Medical History or Other Information

Request for Proposal

Gender Premium rates are partly based on gender. Note: Female rates are higher than male rates so be sure to list the name of your Employer to see if special discounting may be available!

First Name We don't really need to know your name ... but it is nice. Please know that your personal information is sacred to us and will not be shared with anyone without your permission

Last Name

Birthday Premiums rates are partly based on your age.Most disability insurance carriers calculate premiums based on "actual age" while many Life Insurance carriers calculate premiums based on "nearest age"

State of Residence Premiums are also based on your state of residence.

Name of Employer Fortify has access to many special Discount Programs.Note: very often we can offer special discounts based on Employer, Residency/Fellowship Program, Hospital, or Association.

Base Salary Why do we ask this? Disability Income Insurance maximum benefits are based off of income.

Bonus Income

Business Owner As a Business Owner you may be eligible for policy upgrades based on the information provided.Note: This is a great way to save money on this valuable protection!

Occupation In addition to state of residence and age, premiums are also based on your current occupation.

Do you work at least 30hrs/week? Most Disability Income policies require that you are working at least 30 hours per week but Fortify also has options for those working on a part-time basis

Do you have any inforce Disability Insurance Coverage?

Group LTD through Employer?

Individual / Association Coverage?

Additional Individual Policies?

Height Height and weight can be a factor in the rate as Insurance carriers believe elevated weight can increase the risk of future disability.

Weight Height and weight can be a factor in the rate as Insurance carriers believe elevated weight can increase the risk of future disability.

Do you smoke?

Notable Medical History or Other Information

Gender
Premium rates are partly based on gender.
Note: Female rates are higher than male rates so be sure to list the name of your Employer to see if special discounting may be available!

First Name
We don't really need to know your name ... but it is nice.
Please know that your personal information is sacred to us and will not be shared with anyone without your permission

Birthday
Premiums rates are partly based on your age.
Most disability insurance carriers calculate premiums based on "actual age" while many Life Insurance carriers calculate premiums based on "nearest age"

State of Residence
Premiums are also based on your state of residence.

Name of Employer
Fortify has access to many special Discount Programs.
Note: very often we can offer special discounts based on Employer, Residency/Fellowship Program, Hospital, or Association.

Base Salary
Why do we ask this?
Disability Income Insurance maximum benefits are based off of income.

Business Owner
As a Business Owner you may be eligible for policy upgrades based on the information provided.
Note: This is a great way to save money on this valuable protection!

Occupation
In addition to state of residence and age, premiums are also based on your current occupation.

Do you work at least 30hrs/week?
Most Disability Income policies require that you are working at least 30 hours per week but Fortify also has options for those working on a part-time basis

Height
Height and weight can be a factor in the rate as Insurance carriers believe elevated weight can increase the risk of future disability.

Weight
Height and weight can be a factor in the rate as Insurance carriers believe elevated weight can increase the risk of future disability.