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Pilot Disability Insurance Quote

  • Section 1:

  • Pilot Certificate

  • *If you are not a pilot, skip to section 2

  • Ratings:
  • Medical Class:
  • Have you ever had your FAA medical certificate denied or are there any medical restrictions on your medical?

  • Hours flown in the last 12 months for:

  • Hours you anticipate to fly in the next 12 months for:

  • Have you flown or do you plan to fly: (check all that apply)
  • Have you flown or do you intend to fly outside the United States?
  • Do you fly experimental or Ultra-light Aircraft?

  • Section 2:

  • Sex:
  • Do you take any prescription medications?
  • Have you ever had a health condition such as cancer, cardiovascular disease, diabetes, or any major surgeries?
  • Any history of disability, back problems, chronic conditions, or any other medical issues that could effect the underwriting for a disability insurance policy?
  • Ever used tobacco and/or nicotine products in any form?

  • Section 3:

  • Elimination Period:
  • Benefit Period:
  • Any existing Disability Insurance in force?
  • Will you replacing an existing Disability Insurance policy?

 

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