Request Quotes Multi-step Disability Insurance Quotes Let's get started on your disability quotes!What is your name? First Name*Last Name*Email* When were you born? Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 What is your gender? Gender*GenderMaleFemale What state do you live in? State*SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming What is your medical / dental specialty? Medical / Dental Speciality*SelectAllergyAnesthesiologyAnesthesiology (Dental)Anesthesiology/Pain MedicineAnesthetist/CRNAAudiologyBariatric SurgeryCardiology (Diagnostic)Cardiology (Interventional/Invasive)Cardiovascular SurgeryChiropractorColorectal SurgeryCritical CareDental HygienistDental StudentsDermatology (Diagnostic Only)Dermatology (Diagnostic/Invasive)Dermatology (MOHS)DermatopathologyElectrophysiologyEmergency MedicineEndocrinologyEndodontistsFamily PracticeFamily Practice/Sports MedicineGastroenterologyGeneral DentistryGeneral SurgeryGeriatricsGynecologic OncologyGynecologyHematology/OncologyHospitalistsInfectious DiseaseInternal MedicineMaternal and Fetal MedicineMedical StudentsNaturopathNeonatology (Diagnostic Only)Neonatology (Diagnostic/Invasive)Nephrology (Diagnostic Only)Nephrology (Diagnostic/Invasive)Neurological SurgeryNeurologyNurse PractitionersOB/GYNOccupational MedicineOncology (Diagnostic)Oncology (Invasive)Ophthalmology (Diagnostic Only)Ophthalmology (Invasive)Ophthalmology (Retina)OptometryOral and Maxillofacial SurgeryOrthodontistsOrthopedic SurgeryOrthopedic Surgery (Hand)Orthopedic Surgery (Spine)OsteopathOtolaryngology / Head & Neck SurgeryPain MedicinePalliative CarePathology (Diagnostic Only)Pathology (Diagnostic/Invasive)Pediatric AnesthesiologyPediatric CardiologyPediatric Critical CarePediatric DentistryPediatric Emergency MedicinePediatric EndocrinologistPediatric GastroenterologyPediatric Hematology/OncologyPediatric NephrologyPediatric NeurologyPediatric PulmonologyPediatric SurgeryPediatricsPerinatologyPeriodontistsPharmacistsPhysical Medicine and RehabilitationPM&R/Pain MedicinePhysical TherapyPhysician AssistantsPlastic SurgeryPodiatric SurgeryPodiatry (no Surgery)Primary CareProsthodontistsPsychiatryPsychologyPulmonary MedicineRadiation Oncology (Diagnostic Only)Radiation Oncology (Surgical/Procedural)Radiology (Diagnostic)Radiology (Interventional)Radiology (Neuroradiology)Radiology (Nuclear Medicine)RheumatologySleep MedicineSports MedicineSurgical OncologyThoracic SurgeryTransplant SurgeryTrauma SurgeryUrgent CareUrogynecologyUrology (Diagnostic Only)Urology (Diagnostic/Invasive)Vascular SurgeryVeterinarians Small AnimalsVeterinarians Large AnimalsWound CareOtherDid you complete a GPR or AEGD program?SelectYesNoGPR or AEGD?SelectGPRAEGDOtherPlease provide details:Please list program name and graduation date.Is your job:SelectDiagnostic OnlyInvasive and DiagnosticPlease list any board certifications*Please list board certifications and overview of job duties:*Please provide details:*Unfortunately, we are not able to offer competitive disability plans for your medical/dental specialty. What is your employment status? What is your employment status?*SelectEmployeePartner of a GroupSolo PracticeIndependent Contractor / Locum TenensResidentFellowMedical or Dental StudentOtherPlease explain...*Please enter the name of your employer (discounts may apply)*Please enter the name of your program and any affiliated institution (discounts may apply).*What year will you finish residency?*Select2024202520262027202820292030203120322033Will you do a fellowship?*SelectYesNoUnsureFellowship Specialty*SelectAnesthesiology (Dental)Anesthesiology/Pain MedicineBariatric SurgeryCardiology (Diagnostic)Cardiology (Interventional/Invasive)Cardiovascular SurgeryColorectal SurgeryCritical CareDermatology (Diagnostic Only)Dermatology (Diagnostic/Invasive)Dermatology (MOHS)DermatopathologyElectrophysiologyEmergency MedicineEndocrinologyFamily Practice/Sports MedicineGastroenterologyGeneral SurgeryGeriatricsGynecologic OncologyGynecologyHematology/OncologyHospitalistsInfectious DiseaseMaternal and Fetal MedicineNeonatology (Diagnostic Only)Neonatology (Diagnostic/Invasive)Nephrology (Diagnostic Only)Nephrology (Diagnostic/Invasive)Neurological SurgeryNeurologyOccupational MedicineOncology (Diagnostic)Oncology (Invasive)Ophthalmology (Diagnostic Only)Ophthalmology (Invasive)Ophthalmology (Retina)Orthopedic SurgeryOrthopedic Surgery (Hand)Orthopedic Surgery (Spine)Otolaryngology / Head & Neck SurgeryPain MedicinePalliative CarePathology (Diagnostic Only)Pathology (Diagnostic/Invasive)Pediatric AnesthesiologyPediatric CardiologyPediatric Critical CarePediatric Emergency MedicinePediatric GastroenterologyPediatric Hematology/OncologyPediatric NephrologyPediatric NeurologyPediatric PulmonologyPediatric SurgeryPerinatologyPhysical Medicine and RehabilitationPM&R/Pain MedicinePlastic SurgeryPrimary CarePulmonary MedicineRadiation Oncology (Diagnostic Only)Radiation Oncology (Surgical/Procedural)Radiology (Diagnostic)Radiology (Interventional)Radiology (Neuroradiology)Radiology (Nuclear Medicine)RheumatologySleep MedicineSports MedicineSurgical OncologyThoracic SurgeryTransplant SurgeryTrauma SurgeryUrogynecologyUrology (Diagnostic Only)Urology (Diagnostic/Invasive)Vascular SurgeryWound CareOtherWhere will you do your fellowship? (discounts may apply)*Please enter the name of your program and any affiliated institution (discounts may apply)*What year will you finish fellowship?*Select202520262027202820292030203120322033School Name*What year will you finish?*Select202520262027202820292030203120322033Have you finished school, residency or fellowship within the last six months?*SelectYesNoName and location of program/school? (discounts may apply)*What was your approx. graduation date?* MM slash DD slash YYYY How long have you been working as an independent contractor/locums?SelectLess the six monthsLess than one year1-2 yearsMore than two yearsAre you graduating within the next six months?*SelectYesNoHave you been accepted into a residency or GPR/AEGD program?*SelectYesNoPlease enter the name of your future program and start date (discounts may apply)* Do you currently have disability insurance? Do you currently have disability insurance?*SelectNoYes - Individual PlanYes - Group PlanUnsureName of current insurance company?*SelectGuardianMass MutualPrincipalThe StandardAmeritasOhio NationalMetLifeNorthwestern MutualAssociation (ADA, AMA, etc.)OtherPlease type the name of the insurance company...*This field is hidden when viewing the formName of current insurance company? (ARCHIVED)How long have you owned your policy?*SelectJust purchased1-3yrs3-5yrsMore than 5 yearsBenefit amount of current policy?*Select$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000$9,000$10,000$11,000$12,000$13,000$14,000$15,000$16,000$17,000$18,000$19,000$20,000What is your objective?*SelectAdd more coverageReplace coverageGet a better policyGet a better rateAnnual premium of current policy?* What is your income? Income*Please select your income$50,000 - $99,999$100,000 - $149,999$150,000 - $199,999$200,000 - $249,999$250,000 - $299,999$300,000 - $349,999$350,000 - $399,999$400,000 - $449,999$450,000 - $499,999$500,000 - $549,999$550,000 - $599,999$600,000 - $649,999$650,000 - $699,999$700,000 - $749,999$750,000 - $799,999$800,000 - $849,999$850,000 - $899,999$900,000 - $949,999$950,000 - $999,999$1,000,000 and over Would you also like information about... Information About Life Insurance Long Term Care Insurance Financial Planning None of the Above Contact Information Contact Number*Afghanistan+93Åland Islands+358Albania+355Algeria+213American Samoa+1Andorra+376Angola+244Anguilla+1Antigua & Barbuda+1Argentina+54Armenia+374Aruba+297Ascension Island+247Australia+61Austria+43Azerbaijan+994Bahamas+1Bahrain+973Bangladesh+880Barbados+1Belarus+375Belgium+32Belize+501Benin+229Bermuda+1Bhutan+975Bolivia+591Bosnia & Herzegovina+387Botswana+267Brazil+55British Indian Ocean Territory+246British Virgin Islands+1Brunei+673Bulgaria+359Burkina Faso+226Burundi+257Cambodia+855Cameroon+237Canada+1Cape Verde+238Caribbean Netherlands+599Cayman Islands+1Central African Republic+236Chad+235Chile+56China+86Christmas Island+61Cocos (Keeling) Islands+61Colombia+57Comoros+269Congo - Brazzaville+242Congo - Kinshasa+243Cook Islands+682Costa Rica+506Côte d’Ivoire+225Croatia+385Cuba+53Curaçao+599Cyprus+357Czechia+420Denmark+45Djibouti+253Dominica+1Dominican Republic+1Ecuador+593Egypt+20El Salvador+503Equatorial Guinea+240Eritrea+291Estonia+372Eswatini+268Ethiopia+251Falkland Islands+500Faroe Islands+298Fiji+679Finland+358France+33French Guiana+594French Polynesia+689Gabon+241Gambia+220Georgia+995Germany+49Ghana+233Gibraltar+350Greece+30Greenland+299Grenada+1Guadeloupe+590Guam+1Guatemala+502Guernsey+44Guinea+224Guinea-Bissau+245Guyana+592Haiti+509Honduras+504Hong Kong SAR China+852Hungary+36Iceland+354India+91Indonesia+62Iran+98Iraq+964Ireland+353Isle of Man+44Israel+972Italy+39Jamaica+1Japan+81Jersey+44Jordan+962Kazakhstan+7Kenya+254Kiribati+686Kosovo+383Kuwait+965Kyrgyzstan+996Laos+856Latvia+371Lebanon+961Lesotho+266Liberia+231Libya+218Liechtenstein+423Lithuania+370Luxembourg+352Macao SAR China+853Madagascar+261Malawi+265Malaysia+60Maldives+960Mali+223Malta+356Marshall Islands+692Martinique+596Mauritania+222Mauritius+230Mayotte+262Mexico+52Micronesia+691Moldova+373Monaco+377Mongolia+976Montenegro+382Montserrat+1Morocco+212Mozambique+258Myanmar (Burma)+95Namibia+264Nauru+674Nepal+977Netherlands+31New Caledonia+687New Zealand+64Nicaragua+505Niger+227Nigeria+234Niue+683Norfolk Island+672North Korea+850North Macedonia+389Northern Mariana Islands+1Norway+47Oman+968Pakistan+92Palau+680Palestinian Territories+970Panama+507Papua New Guinea+675Paraguay+595Peru+51Philippines+63Poland+48Portugal+351Puerto Rico+1Qatar+974Réunion+262Romania+40Russia+7Rwanda+250Samoa+685San Marino+378São Tomé & Príncipe+239Saudi Arabia+966Senegal+221Serbia+381Seychelles+248Sierra Leone+232Singapore+65Sint Maarten+1Slovakia+421Slovenia+386Solomon Islands+677Somalia+252South Africa+27South Korea+82South Sudan+211Spain+34Sri Lanka+94St. Barthélemy+590St. Helena+290St. Kitts & Nevis+1St. Lucia+1St. Martin+590St. Pierre & Miquelon+508St. Vincent & Grenadines+1Sudan+249Suriname+597Svalbard & Jan Mayen+47Sweden+46Switzerland+41Syria+963Taiwan+886Tajikistan+992Tanzania+255Thailand+66Timor-Leste+670Togo+228Tokelau+690Tonga+676Trinidad & Tobago+1Tunisia+216Turkey+90Turkmenistan+993Turks & Caicos Islands+1Tuvalu+688U.S. Virgin Islands+1Uganda+256Ukraine+380United Arab Emirates+971United Kingdom+44United States+1Uruguay+598Uzbekistan+998Vanuatu+678Vatican City+39Venezuela+58Vietnam+84Wallis & Futuna+681Western Sahara+212Yemen+967Zambia+260Zimbabwe+263Comments?EmailThis field is for validation purposes and should be left unchanged.
