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Disability Quote
HKFS Disability Quote Request
Fax Request to Insurance Dept. at (563) 582-1040 or email to e-quotes@hkfs.com
Honkamp Krueger Financial Services, Inc. 2355 J.F.K. Road, Dubuque, IA 52002-2835 Phone: (563) 582-2855
Information
Agents Name :
*
CPA Name:
*
Date:
*
Return to:
*
Fax#
*
Email
*
Date needed:
*
Owner # 1:
*
M or F
*
Male
Female
DOB:
*
Owner # 2:
M or F
Male
Female
DOB:
Occupation:
*
How long:
Describe Duties:
*
State:
Employment Income:
*
Employee Bonus:
Have you used tobacco products?
*
Yes
No
Types used:
Cigarettes
Chewing Tobacco
Cigars
Pipe Smoking
Frequency:
#per Day
#per Week
#per Month
#per Year
Business Owner:
How long owned?
What percentage owned?
Entity type?
How many employees?
Plan Type:(please check one option in each column)
Product
Elimination Period
Benefit Period
Current
Individual DI
Employment Agency
Business Overhead
Buy-Sell
Key Person
Excess Disability
High Risk DI
Proposed
Individual DI
Employment Agency
Business Overhead
Buy-Sell
Key Person
Excess Disability
High Risk DI
Current
30 days
60 days
90 days
180 days
365 days
730 days
Proposed
30 days
60 days
90 days
180 days
365 days
730 days
Current
1 year
2 year
3 year
5 year
10 year
To age 65
To age 67
Life
Proposed
1 year
2 year
3 year
5 year
10 year
To age 65
To age 67
Life
Benefit Requested:
Base
Social Security Integration
Riders:
Own Occupation
Residual/Partial
Premium Refund
COLA
Future Purchase Option
Any other Riders Requested:
Other Applications applied for:
Definitions for Disability Quote Request
Base
- Amount of benefit that will be paid regardless of any other payments such as Workers Comp or Social Security.
Social Security Integration
– Benefit paid is the amount of Social insurance minus Social Security and/or Workers Comp.
Own Occupation
– Best definition of disability. May allow payment even if working at another job. Not all insurance companies offer.
Residual/Partial
- % of benefit paid if loss of income due to disability, but able to work part time. Usually need 20% loss of income or more.
Premium Refund
– Premiums refunded minus any claims.
COLA
– Cost of living adjustment increases benefit during claim to help keep up with inflation.
Future Purchase Option
– This allows insured to increase monthly benefit without proving insurability.
Qualifying income is required, however.