Advance Life Insurance

$10,000 AdvanceCare Simple Level Premium Term: 10 years

To get your rate quote for this term life insurance policy, please complete the information below.

Applicants must be older than 1 year and younger than age 65 to apply for coverage. There is a reduced death benefit for the first two policy years. A benefit may be paid for accidental death in a covered accident as defined in the Policy during this period.

This life insurance coverage is offered and underwritten by Advance Insurance Company of Kansas, a wholly-owned subsidiary of Blue Cross and Blue Shield of Kansas and an independent licensee of the Blue Cross and Blue Shield Association.

Applicant Information

* All fields are required except where marked optional.

Applicant

First Name

Last Name

Suffix (optional)

Social Security Number

Birthdate

Gender

Male

Female

Tobacco Use

Yes

Residential ZIP Code

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