Accidental Death Coverage at Life Quotes, Inc.

Did You Know?

Unintentional injury is the #1 leading cause of death for ages 1-44.

The Fidelity Life policy asks no health questions and has very affordable premiums

Benefit Doubled For Travelers

Yes! This policy pays double the face amount if you die while a passenger in a public conveyance being operated by a common carrier to transport passengers for hire such as an airline, taxi, train or passenger ship.

"Life Quotes has been fabulous. Thanks for the great service."
-- John G.

Up to $250,000 of Accidental Death Insurance 5 minute online enrollment, follow each step

Step 1: Select Individual or Family Coverage

IMPORTANT NOTE - If the owner of the policy will be someone other than the insured, the maximum coverage amount allowed shall be $50,000. Please check to confirm your acknowledgement and understanding.

Ready to Buy? Start by selecting the coverage you want (choose one):

Coverage Amount	Individual Coverage		Family Coverage
Coverage Amount	Monthly Premium	Annual Premium	Monthly Premium	Annual Premium
$100,000	$13.40	$154.00	$17.31	$199.00
$150,000	$17.70	$203.50	$23.58	$271.00

* Fidelity Life Association has a maximum limit of $250,000 per insured on its Accidental Death Benefit policy. Multiple policy purchases which exceed $250,000 are not permitted.

Step 2: View Financial Strength Ratings

FIDELITY LIFE ASSOCIATION IL, NAIC# 63290

	Rating Agency	Latest Rating
	A.M. Best	A- (Eff. 6/1/2016) Fourth highest of 16 ratings
	Fitch Ratings	NR
	Moody's	NR
	Standard & Poor's	NR

Ratings Explanation Company Balance Sheet

Step 3: View Policy Summary Information	Company's consumer brochure

Policy Description

Policies issued by Fidelity Life Association, A Legal Reserve Life Insurance Company, Chicago, IL, and are not available to residents of CO, FL, MA, NY and WY.

You must be a U.S. Citizen to apply.

Accidental Death Benefit coverage provides from $50,000 to $250,000 of security for a covered accidental death. Coverage is guaranteed regardless of health or occupation if you are between the ages of 20 and 59. There are no long forms to fill out and no medical exams are required. The affordable monthly premiums are guaranteed to never increase. The benefits are also guaranteed to remain unchanged until age 70, at which time they are reduced by 50% until the coverage expires at age 80.

If you choose the Family Accidental Death Benefit Rider, the principal benefit for the spouse and any dependent child will be equal to a percentage of the primary insured's principal benefit as of the date of accident. This is based on the insured's family composition on the same date.

For the spouse, the principal benefit will be equal to 60% of the primary insured's principal benefit if there is no dependent child; or 50% if there is one or more dependent children. For each dependent child, the principal benefit will be equal to 10% of the primary insured's principal benefit if there is a spouse; or 20% if there is no spouse.

Included at no additional cost are two benefits that enhance the value of this coverage in certain automobile and common carrier (e.g. commercial airline) accidents.

Auto Safety Benefit

If the insured dies due to an accident while operating or riding as a passenger in a private passenger automobile, the death benefit will be increased by 10% provided the insured was wearing a properly fastened, and originally factory installed seat belt at the time of the accident.

Travel Accident Benefit

The Travel Accident Benefit pays an additional 100% for accidents in which the insured was a passenger in a public conveyance being operated by a common carrier to transport passengers for hire.

Know these Policy Exclusions* before You Buy

No benefits shall be paid for death caused by:

Suicide: Suicide, while the Insured is sane or insane.
War: War, declared or undeclared, or any act of war. War is defined as armed conflict between nations, or between factions in the same nation.
Military Service: Service in the military forces of any country at war or in any civilian noncombatant unit serving with those forces. "War" includes undeclared war. "Country" includes any international organization or group of countries.
Aviation: Travel in, or descent from or with, any kind of aircraft aboard which the Insured is a pilot or crewmember or is giving or receiving any training. "Crewmember" includes anyone who has any duty aboard the aircraft.
Natural Causes: Bodily or mental illness, disease or infirmity of any kind or medical or surgical treatment for any of these.
Drug: The taking or injection of any nonprescription drug, hypnotic or narcotic, accidentally or otherwise.
Blood Alcohol: Death while the Insured is operating a motor vehicle and is determined to have a blood alcohol level exceeding the legal limit as defined by state law.
Speed Contest: Fatal injury, which is incurred as the result of taking part in any speed contest.
Felony: Injury received while committing a felony.

* Note: Exclusions can vary depending on your state of residence.

Step 4: Application for Accidental Death Benefit Coverage Underwritten by Fidelity Life Association, Chicago, Illinois

YOU ARE NOW ON A SECURE SERVER. Please enter the following information exactly as you would like it to appear on the insurance application. Or...call us at 1-800-324-6370 and we'll accept this information from you by phone.

Applicant Information

Name
Suffix (e.g., "Jr."):

First Name

M.I.

Last Name

Suffix (Title)

Street address:

City, State & Zip:

Cell phone:

()-

Day phone:

()- Ext.

Evening phone:

()- Ext.

Email Address:

Birth Date:

Sex:

Male Female

Social Security#:

Driver's License #:

Driver's License State:

Occupation:

Employer or Business Name:

Are you a United States citizen or do you have Permanent Resident (Green Card) status?	Yes No
U.S. Citizenship or permanent resident status is required for eligibility for this coverage. Please be advised that we cannot accept your application.

State of Birth:

Do you have any life insurance in force or is any application for life insurance, or reinstatement, now pending? Do you have any accident and sickness insurance in force or is any application for life insurance, or reinstatement, now pending? Do you have any accident and sickness insurance in force or is any application for accident and sickness insurance, or reinstatement, now pending?	Yes No

Who is the owner of the policy?	Applicant Other

Beneficiary Information

Primary Beneficiary:

Primary Beneficiary's Relationship to You:

If 'Other', please explain:

Primary Beneficiary's SS# or Tax ID:

Credit Card Payment Information

As a convenience to me, I authorize Fidelity Life Association to make electronic debits or other forms of preauthorized withdrawals from my financial institution as indicated below. I understand that if a debit or withdrawal is not honored by the financial institution, Fidelity Life will consider the premium unpaid. Any debit or withdrawal returned due to insufficient funds may be redeposited by Fidelity Life at its sole discretion. This authorization will remain in effect until written notice by the depositor/card holder is received by Fidelity Life. I further agree that if any such debit or withdrawal is not honored, whether with or without cause, Fidelity Life shall be under no liability whatsoever even though such dishonor results in the lapse of insurance.

I Agree

Cardholder's Name:
Same As Above

First Name

M.I.

Last Name

Suffix

Credit Card Type:

Credit Card Number:

Expiration Month/Year:

Billing Address:
Same As Above

Billing City, State & Zip:

Notice of Insurance Information Practices

I declare that each answer given to the questions contained in this application is complete and true to the best of my knowledge and belief. I understand and agree that the Company will rely on these answers, and the answers and statements I may give in any other form taken as a part of this application as representations and not warranties. I also understand that the Company reserves the right to accept or deny this application after taking into account whatever information may be available to it, including availability as to coverage by its reinsurers. The coverage will be effective on its date of issue if the: (a) habits; (b) occupation; and (c) any other condition relating to the Proposed Insured are as described in the application.
						Fraud Warning: Any person who knowingly presents a false or fraudulent claim for payment of a loss or knowingly makes a false statement in an application for insurance may be guilty of criminal offense under state law.

I Agree

Insurance Co. Name: Fidelity Life Association

Company Policy Name: Accidental Death Benefit

Life Quotes, Inc. ID: 6395