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No Exam Life Insurance Quote

Michigan Residents Only!

By filling out this form below you acknowledge that in order to qualify, you must be able to answer "NO" to all of the following questions: Click Here for a standard medical exam quote form.

Do you have, or during the past 10 years, have you been diagnosed or treated by any medical professional for:

Cancer (other than Basal Cell skin cancer), Heart Disease including Heart Attack, Stroke, Angina, Arterial Disease of the Heart or Extremities or Congestive Heart Failure, Diabetes, Liver Disease, Alzheimer’s Disease, Multiple Sclerosis, Lupus, Kidney Disease, Ulcerative Colitis, Crohn’s Disease, Seizures, Brain or Nervous System Disorder, Emphysema, Chronic Lung Disorder, Mental or Nervous Disorder, Alcoholism, Drug Abuse, Acquired Immune Deficiency Syndrome (AIDS), positive result of a Human Immunodeficiency Virus (HIV) test, or AIDS Related Complex (ARC)?

2. Are you currently confined to a hospital or nursing facility, or have you been advised by any medical professional during the past 3 years, to have any surgery, additional diagnostic testing, hospital confinement, or nursing facility confinement, and have not yet done so?

3. In the past 5 years, have you been refused, rejected or postponed for Life Insurance?

If you answered "NO" to all of the questions above, then you Qualify! Please fill out the form below and we will begin processing your quote immediately upon receiving it.

Coverage Amount Requested ($10,000 up to $250,000)
Term or Whole life?
Have you used tobacco in the last 24 months?

Date of Birth
/ /
First Name
Last Name
Primary Phone Number
E-Mail Address
ZIP / Postal Code

Important Notice:

Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages.  Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company.  If you have any questions, please feel free to contact us. Per the terms of our online privacy policy we will not resell your information to any third-party.

Fill out the form below to get started with an insurance quote