Disability Quote – OCi Services

Agent Name:*

Agent Company:

Agent Email:*

Agent Phone:*

Disability Income plans typically cost 2-3% of client’s total income. Have you discussed this with your client?

Yes
No

Please discuss this with your client before requesting a quote.

Please choose the OCI Sales Executive helping you with this case:*

Insured Name:*

Date of Birth:*

Height & Weight:*

Gender:*

Male
Female

State:*

Tobacco User?*

Yes
No

Annual Gross Income:*

Existing Group Coverage?*

Yes
No

% of Salary Covered:*

Monthly Benefit Cap:*

Occupation and Duties (More specific the better - please note if insured is government/state employee):*

Business Owner (at least 20% and owned business for at least 2+ years)?*

Yes
No

Is the individual self-employed?*

Yes
No

Is the individual a W-2 employee?*

Yes
No

Plan Design

Note: Individual DI coverage does not cover pregnancy.

Elimination Period:*

Benefit Period:*

Desired Monthly Premium Amount:*

Premium Mode:*

Benefit Amount*

Additional comments, health concerns, or medications? Note: Individual Disability insurance does NOT cover maternity leave.

VERY IMPORTANT: Over 40% of disability cases are rated, declined, or carry exclusions. Eliminate the surprise for your client and increase your closing percentage by asking your client about any known health conditions. Specifically ask if they have a history of neck or back disorders, diabetes, cardiac conditions, depression/anxiety, sleep apnea, or cancer.

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