Welcome to your Virtual Interactive Presentation! We will provide you with a V.I.P. experience to enhance your benefits. You can see and interact with the coverages that will protect you and your loved ones for the upcoming year.
Let's work through this together!
Name
*
FIRST NAME
LAST NAME
Date of Birth
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PHONE NUMBER
*
EMAIL
*
example@example.com
SPOUSE NAME
First Name
Last Name
Date of Birth
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you covering any children under the age of 26?
YES
NO
How many children
1
2
3
4
5
6
7
8
9
more
CHILD NAME 1
Gender
Male
Female
DATE OF BIRTH
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
CHILD NAME 2
Gender
Male
Female
DATE OF BIRTH
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
CHILD NAME 3
Gender
Male
Female
DATE OF BIRTH
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
CHILD NAME 4
Gender
Male
Female
DATE OF BIRTH
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
CHILD NAME 5
Gender
Male
Female
DATE OF BIRTH
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
CHILD NAME 6
Gender
Male
Female
DATE OF BIRTH
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
CHILD NAME 7
Gender
Male
Female
DATE OF BIRTH
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
CHILD NAME 8
Gender
Male
Female
DATE OF BIRTH
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
CHILD NAME 9
Gender
Male
Female
DATE OF BIRTH
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Enter number of kids
Review the programs below to understand the benefits available to you. By clicking the rates and coverages you will have the ability to tally multiple plans while creating a proactive strategy to protect your financial impact of health related incidents.
Enjoy the videos and interactive rates with full brochures below .
Accident program
This plan can help if you seek treatment for an injury
Accident Level 2 ***This is an program that pays you if you receive treatment for an injury***
5.40 Cover yourself
8.28 Cover you and your children
7.08 Cover you and your spouse
10.29 Cover your Family
0.00 No coverage
Beneficiary information
The Accident plan you selected has an Accidental death and dismemberment payment of $25,000. Who would you like your beneficiary to be?
Full Name
Relationship
DATE OF BIRTH
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hospital Choice
This plan can help pay hospital deductibles
Pick your age category
*
18 - 49
50 - 59
60 - 75
Hospital Choice Base plan $1,000 ****This program assists with large deductibles
6.42 Cover yourself
8.10 Cover you and your children
9.45 Cover you and your spouse
9.57 Cover your Family
0.00 No coverage
Hospital Choice Base plan $1,000 ****This program assists with large deductibles
6.30 Cover yourself
7.98 Cover you and your children
8.91 Cover you and your spouse
9.48 Cover your Family
0.00 No coverage
Hospital Choice Base plan $1,000 ****This program assists with large deductibles
6.60 Cover yourself
8.22 Cover you and your children
10.08 Cover you and your spouse
10.20 Cover your Family
0.00 No coverage
Short term disability
Protect your income with a disability policy. This plan pays 1st day of an injury and 14th day of an illness over a Three month period.
Click your age
*
18 - 49
50 - 64
64 - 74
Use this slider to discover what you are eligible for as a monthly benefit amount.
You can choose up to your eligible amount above. You can also choose a lesser amount. Most people make sure their rent, mortgage and utilities can be covered with this amount.
You can choose up to your eligible amount above. You can also choose a lesser amount. Most people make sure their rent, mortgage and utilities can be covered with this amount.
You can choose up to your eligible amount above. You can also choose a lesser amount. Most people make sure their rent, mortgage and utilities can be covered with this amount.
Pick your age category
*
18 - 29
30 - 39
40 - 49
50 - 70
Plus Rider $5,000 ***This asset can be added to Hospital or Disability plans
0.72 Cover yourself
1.44 Cover you and your children
1.35 Cover you and your spouse
1.74 Cover your Family
0.00 No coverage
Plus Rider $5,000 ***This asset can be added to Hospital or Disability plans
1.02 Cover yourself
1.56 Cover you and your children
2.01 Cover you and your spouse
2.25 Cover your Family
0.00 No coverage
Plus Rider $5,000 ***This asset can be added to Hospital or Disability plans
1.74 Cover yourself
2.10 Cover you and your children
3.30 Cover you and your spouse
3.39 Cover your Family
0.00 No coverage
Plus Rider $5,000 ***This asset can be added to Hospital or Disability plans
2.97 Cover yourself
3.06 Cover you and your children
5.67 Cover you and your spouse
5.70 Cover your Family
0.00 No coverage
Additional support
Call me as soon as you can so I can have coverage
I would like more information. Let's talk!
I have Aflac already and would like to review my policies
WEEKLY TOTAL
You did it!
We hope this was helpful and it provided you with the knowledge to better protect your financial strategies and secure what you've worked so hard for.
S U B M I T
After hitting submit your company representative will contact you within 48 hours to assist you with any questions and elections.
Thank you and be safe!
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