New York Disability Insurance Quote

Applicant Information

First Name:

Last Name:

Address:

City:

State (New York, CT or NJ):

Zip Code:

Daytime Phone:

Cell Phone:


Email:  (Required)


How Best To Contact You:
Select One Cell Phone Daytime Phone Email

Currently Insured:
Select One Yes No


Disability Insurance Information

Date of Birth:

Gender:
Select One Female Male
Height:

Weight:


Do You Smoke:
Select One Yes No

Currently Own Disability Insurance:
Select One Yes No

Type of Disability Insurance Owned:


Monthly Gross Income:
$

Occupation or Title:


Explain Job Responsibilities:


Are you a government employee:
Select One Yes No

Are you a business owner:
Select One Yes No



Disability Coverage Information

Length of Coverage Needed:
Select One Short Term (Less than 2 years) Long Term (2 years or more)

Disability Coverage For:
Select One Myself Only Me & Spouse Spouse Only

Type of Coverage Needed:
Select One Accident Only Health Only Accident & Health

Monthly Benefit Amount Desired:
Select Amount 1,500 1,750 2,000 2,250 2,500 3,000 3,500 4,000

Or Enter a Different Monthly Amount:
$

Benefit Period:
Select One 13 weeks (Short Term Policy Only) 26 weeks (Short Term Policy Only) 1 year (Short Term Policy Only) 2 years (Long Term Policy Only) 5 years (Long Term Policy Only) To Age 65 (Long Term Policy Only)

Elimination Period:
Select One None 60 days 90 days 180 days 1 year 2 years

Payment Mode:
Select One Annual Semi-Annual Quarterly Monthly


Explain any prior workers comp
or serious health issues below:




Question or Message:




Click the "Submit Quote Request"
button below to send your New York
Disability Insurance request to
Direct Access Group Benefits.


***By submitting this request you
acknowledge that this is neither
an offer to insure nor a guarantee
of insurance.***


            





We are a Somers, NY insurance
agency offering affordable New York
disability insurance quotes in the
following towns, cities and counties
in the Westchester County, NY area:
Port Chester, Harrison, Mamaroneck,
Larchmont, New Rochelle, Yonkers,
White Plains, Rye Brook, Scarsdale,
Rye, Ardsley, Hartsdale, Bronxville,
Mount Vernon, Irvington, Valhalla,
Elmsford, Dobbs Ferry, Hastings
on Hudson, Greenburgh, Tarrytown,
Sleepy Hollow, Hawthorne,
Scarborough, Thornwood, Briarcliff
Manor, Ossining, Harmon, Montrose
Crugers, Buchanan, Peekskill, Millwood,
Pleasantville Armonk, Chappaqua, North
Castle, Mt. Kisco, Bedford, Pound Ridge,
Bedford Hills, Cross River, South Salem,
Yorktown Heights, Goldens Bridge,
Amawalk, Yorktown, Katonah, Salem
Center, Somers, North Salem, Croton
Falls, Jefferson Valley, Shrub Oak,
Palisades, Sparkill, Tappan, Orangeburg,
Pearl River, West Nyack, New City,
Nanuet, Chestnut Ridge, Montebello,
Suffern, Monsey, Spring Valley, Congers,
Nyack, Rockland Lake, Wesley Hills,
New Hempstead, Pomona, Sloatsburg,
Ramapo, Hilburn, Willow Grove, Mt. Ivy,
Thiells, Tomkins Cove, Ladentown,
Haverstraw, Stony Point, Tomkins Cove,
West Haverstraw, Bear Mountain, Jones
Point, Newburgh, Middletown, Bronx,
New York City, Brewster, Poughkeepsie,
Putnam County, Orange County, and
Rockland County, New York.


Copyright 2017 OasisEarth Internet Group,
All Rights Reserved

In addition to Disability Insurance, we also offer affordable Health Insurance policy premiums or choose another New York, CT, or NJ family insurance coverage from the list below.

Do you have questions about disability insurance policies?

also CT & NJ

Long Term Care Insurance Quote

Life Insurance Quote

New York Personal Insurance Quotes

Disability Insurance Quote

Call Us 1-800-498-1819

Contact Us

Private Exchange

About Us

Privacy Statement

Disclaimer / Legal

Site Map

Personal Insurance

Physician Search

Group Insurance

Online Insurance Forms

Resources

Insurance Carriers

Quote Forms

With more than 20 years of offering affordable group insurance services to both large employers and small business throughout New York, Connecticut, and New Jersey. We're an independent insurance agency and therefore able to consistently offer cost effective disability insurance coverage which is driven by a total commitment to service.

[ Home ]

© 2002, OasisEarth Internet Group, All Rights Reserved