Covered By Us Long-Term Care InsuranceSTART YOUR QUOTE!Long-Term Care InsurancePage 1 of 2Personal InformationGender*Please selectMaleFemaleNon BinaryNameEmail address*Phone Number*Date of Birth*Marital StatusPlease selectSingleMarriedDivorcedWidowedSeparatedRegistered Domestic PartnerUn-registered domestic partnerStreet Address*Apt/Suite*Zip Code*City, State*About yourselfHeight*Weight*Have you bought life insurance in the last 5 years?YesNoBy clicking the 'Continue' button, I agree to the CoveredByUs Privacy Policy and Terms of Use, and I give consent to share my information with CoveredByUs ’s Affiliates, External Marketing Partners, and their successors and assigns. Please note that the Terms of Use contain a mandatory arbitration provision and class action waiver. For all of these, I also give my express written consent to be contacted at the mobile phone number provided above for marketing purposes by call, text, or automated telephone dialing system, including with an artificial or prerecorded voice, which may leave a message. Message and data rate may apply. Message frequency varies. Text HELP for help and STOP to cancel at any time. I understand that I am providing this consent even if my telephone number is currently listed on a federal, state, internal, or corporate Do-Not-Call list. I understand that I do not have to agree to receive these types of calls or text messages as a condition of purchasing any goods or services. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.ContinueAdditional InformationHave you used tobacco or other nicotine related product?*NeverLess than a year2 years3 years4 or more yearsAre you being treated for high blood pressure or cholesterol?YesNoAre you currently being or have you ever been treated for alcohol or drug use?*NeverMore than 5 years agoLess than 5 years agoHave any of your parents or siblings died prior to age 60 from cancer, stroke or a heart disorder?*NoneOne deathMore than one deathHave you ever had any DUI or reckless driving charges?*NoYes, less than 5 years agoYes, more than 10 years agoDo you participate in hazardous sports?YesNoCoverage Amount*50,000100,000200,000400,000600,000700,000+Insurance term*5 years10 years15 years20 year +BackSubmitThis field should be left blank
