Please fix invalid entries

InFlex - Flexible Life Insurance

First name cannot be empty

Last name cannot be empty

arrow&v

Coverage Amount

arrow&v

Qualified Insurance Premium

Please enter a valid address

Unqualified Insurance Premium

Please select a date of birth

Please enter a valid city

Please enter a valid zip code

Please enter a valid email address

Qualified Document

Qualified Profile ( MIB / Doctor Profile Upload)

Coverage Qualifiers and Personal Conditions

Qualifier 1.  Health and Activity

In this qualifier InFlex would like to know the quality of your overall health and how well you take care of yourself. This includes a regular exercise program or regiment, having no major issues and no more than two doctor prescriptions for other than the major health items described in further qualifiers.

 

The question is have you been in good health for the described time on the right?

Qualifier 2.  Heart Disease

In this qualifier InFlex would like to know if you have had or know of any heart disease, coronary issues, treatment for heart or coronary issues. This includes a program, regiment or doctor prescriptions heart or coronary conditions.

The question have you had any heart or coronary issues or treatment within the described time on the right?

Please select an option

Please select an option

Qualifier 3.  Parents Health

In this qualifier InFlex would like to know if any of your parents / grand parents have died from either cancer or heart/coronary issues.

 

Have either parents or grandparents has died from cancer or heart/coronary issues described on the right?

Please select an option

Qualifier 4.  Non-Prescription Drug Use

In this qualifier InFlex would like to know if you have had or know of any heart disease, coronary issues, treatment for heart or coronary issues. This includes a program, regiment or doctor prescriptions heart or coronary conditions.

The question have you had any heart or coronary issues or treatment within the described time on the right?

Please select an option

Qualifier 5.  Smoking / Tobacco Use

In this qualifier InFlex would like to know if have used on a regular basis any tobacco products or smoked, cigarettes, cigars, or other tobacco products.

 

Have you smoked or used tobacco products regularly as described on the right?

Please select an option

Qualifier 6.  Life Behavior

In this qualifier InFlex would like to know if you engage in any activities, recreational sports that add a level or risk to your life.  i. e. Parachuting, hang-gliding, small craft flying, xGames etc.

The question is how often do you engage in these activities as described time on the right?

Please select an option

Qualifier 7.  Cancer Health

In this qualifier InFlex would like to know if any of you have been treated for either cancer in any form i. e. lung, breast, leukemia, thyroid, etc.

 

Have have you been treated for cancer or issues / complications during the described time frame on the right?

Please select an option

Qualifier 8.  Diabetes

In this qualifier InFlex would like to know if you have had or know of any diabetes or treatment for endocrinology disease,  issues. This includes a program, regiment or doctor prescriptions for endocrinology issues.

The question have you had any diabetes / endocrinology issues or treatment within the described time frame on the right?

Please select an option

Qualifier 9.  Work / Military

In this qualifier InFlex would like to know if you engage in any work related activities or currently in active duty for military armed forces.  Specifically, occupation that will add a level or risk to your life.  i. e. High risk jobs or active deployment for military.

The question is how often do you engage in these activities as described time on the right?

Please select an option

Qualifier 10.  Suicide

In this qualifier InFlex would like to know if you have had thoughts or treatment for  suicide issues. This includes a program, regiment, doctor prescriptions or therapy.

The question is have you had any thoughts of suicide that were significant either attempted to take your life or to need intervention, a program, regiment or doctor prescriptions, therapy within the described time on the right?

Please select an option