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Home
About Us
Services
Life Insurance Plans
Final Expense/Burial Insurance
Different Types of Life Insurance
Tax Free Retirement Income Plans
Long-Term Care
Medicare Plans
Medicare Supplement Insurance Plans
Medicare Advantage Plans
Medicare Prescription Drug Plans
VBA Membership
Health Insurance Plans
Business Insurance
Home Insurance
Dental Vision, Cancer & Accident
Blogs
Get a Quote
+1 (727) 392 8404
Final Expense
Find Out if I Qualify for Immediate Benefits
What is your name?
What is your zip code?
Do you currently receive kidney dialysis, require oxygen use, or have you received or been diagnosed by a licensed member of the medical profession as needing an organ transplant? Alternatively, have you been diagnosed by a licensed member of the medical profession as having a terminal illness? (Terminal illness is defined as any illness diagnosed that would reasonably be expected to cause death within 24 months.)
yes
No
Do you require assistance to feed, bathe, dress, or take your own medication? Alternatively, are you currently confined to a hospital, nursing home, medical-related facility, or require home health nursing care?
yes
No
Have you tested positive for exposure to HIV infection or been diagnosed as having ARC or AIDS caused by HIV infection or another sickness or condition derived from such infection?
yes
No
Have you ever been diagnosed with, treated for, or been given medical advice by a licensed member of the medical profession for Alzheimer’s disease, dementia, mental incapacity, or cognitive impairment?
yes
No
In the past 12 months:
Have you been confined to a hospital two or more times?
yes
No
Have you been treated for or diagnosed by a licensed member of the medical profession with any cancer (other than basal cell skin cancer), heart attack, congestive heart failure, cardiomyopathy, stroke, or heart surgery (including angioplasty)?
yes
No
Have you used any illegal drugs or been treated for or advised to have treatment for drug abuse by a licensed member of the medical profession?
yes
No
In the past 2 years:
Have you been diagnosed with, treated for, been advised to seek treatment for, or consulted with a licensed member of the medical profession regarding:
Diabetes with complications of retinopathy (eye), nephropathy (kidney), or neuropathy (nerve damage or numbness)?
yes
No
Any form of cancer (other than basal cell skin cancer) or brain tumor?
yes
No
Coronary artery disease (CAD), heart attack, heart valve disease, cardiomyopathy, congestive heart failure, aneurysm, stroke, irregular heart rhythm, peripheral artery disease (PAD / PVD), or had surgery for any heart disorders (including angioplasty) or circulatory disorders (excluding varicose veins)?
yes
No
Sickle cell anemia, kidney disease (including renal insufficiency, renal disease, or any condition that required dialysis), or liver disease (including cirrhosis, hepatitis, including B or C)?
yes
No
Lung disease or respiratory disease, including chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, or any other type of chronic lung disease or ongoing respiratory disorder (excluding controlled, mild asthma not requiring any hospitalization in the past 2 years)?
yes
No
ALS (Lou Gehrig’s disease), Parkinson’s disease, muscular dystrophy, multiple sclerosis, Huntington’s disease, or seizure disorder with seizures within the past 2 years?
yes
No
Have you been advised by a licensed member of the medical profession to have any tests (excluding an HIV test), surgery, treatment, or further medical evaluation that have not been performed? Or do you have any medical test (excluding an HIV test) results pending?
yes
No
Have you been treated for, been advised to limit or discontinue use of, or advised to have treatment for alcohol or drug abuse by a licensed member of the medical profession, or abused or misused prescription drugs?
yes
No
In the past 7 years, have you been convicted of a felony or currently have pending charges for a felony? Or are you currently on parole from a felony conviction?
yes
No
In the past 7 years, have you been convicted of a felony or currently have pending charges for a felony? Or are you currently on parole from a felony conviction?
yes
No
Current Age
Sex
Male
Female
What is the best email to send you your eligibility status?
What is the best phone number to contact you incase we need more information to determine whether or not you qualify?
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