top of page
Clarity Coverage
Contact us
Menu
Home
Free Quote
Living Benefits
Contact Us
Privacy Policy
Close
Request a free quote:
First name
(Required)
Last name
(Required)
Email
State
(Required)
Date of Birth
(Required)
Month
Day
Year
Pick the option that fits your situation:
(Required)
When would you like to be covered by?
(Required)
I’m ready today
Within a week
I’m not sure
Would you consider your health to be average, good, or excellent?
(Required)
Average
Good
Excellent
Do you have an idea of how much coverage you'd like? (If unsure, leave blank)
Phone
(Required)
I agree to receive text messages (SMS) regarding my life insurance quote and related updates. Message & data rates may apply. Consent is not required to purchase.
(Required)
Yes
No
Cardviovasulcar
Heart attack
Stroke/TIA
Heart murmur
Arrhythmia (A-fib, flutter)
Pacemaker
Srent/angioplasty
Bypass
Valve replacement
Congestive heart failure
Cardiomyopathy
Peripheral artery disease
Hypertension
Cardiovascular Medications
Aspirin
Plavix (Clopidogrel)
Brilinta (Ticagrelor)
Effient (Prasugrel)
Warfarin (Coumadin)
Eliquis (Apixaban)
Xarelto (Rivaroxaban)
Pradaxa (Dabigatran)
Atenolol
Metoprolol
Carvedilol
Propranolol
Lisinopril
Enalapril
Ramipril
Losartan
Valsartan
Irbesartan
Amlodipine
Diltiazem
Verapamil
Nifedipine
Hydralazine
Isosorbide Mononitrate
Nitroglycerin
Digoxin
Spironolactone
Furosemide
Bumetanide
HCTZ (Hydrochlorothiazide)
Cancer & Tumors
Any cancer history
Leukemia
Lymphoma
Melanoma
Brain tumors
Cancer & Tumors Medications
Tamoxifen
Anastrozole (Arimidex)
Letrozole (Femara)
Exemestane (Aromasin)
Fulvestrant (Faslodex)
Trastuzumab (Herceptin)
Pertuzumab (Perjeta)
Lapatinib (Tykerb)
Imatinib (Gleevec)
Dasatinib (Sprycel)
Nilotinib (Tasigna)
Rituximab (Rituxan)
Obinutuzumab (Gazyva)
Bendamustine
Cyclophosphamide
Methotrexate
Doxorubicin
Vincristine
Paclitaxel (Taxol)
Docetaxel (Taxotere)
Cisplatin
Carboplatin
Oxaliplatin
Fluorouracil (5-FU)
Capecitabine (Xeloda)
Everolimus (Afinitor)
Palbociclib (Ibrance)
Olaparib (Lynparza)
Pembrolizumab (Keytruda)
Nivolumab (Opdivo)
Respiratory
COPD
Emphysema
Asthma
Sleep apnea
Chronic bronchitis
Tuberculosis
Oxygen use
Respiratory Medications
Albuterol (Ventolin, ProAir)
Levalbuterol
Salmeterol
Formoterol
Indacaterol
Olodaterol
Fluticasone (Flovent)
Budesonide (Pulmicort)
Mometasone (Asmanex)
Beclomethasone (QVAR)
Ciclesonide (Alvesco)
Advair (Fluticasone/Salmeterol)
Symbicort (Budesonide/Formoterol)
Breo Ellipta (Fluticasone/Vilanterol)
Trelegy Ellipta (Triple combo)
Tiotropium (Spiriva)
Umeclidinium
Glycopyrrolate
Ipratropium
DuoNeb (Ipratropium/Albuterol)
Theophylline
Montelukast (Singulair)
Roflumilast (Daliresp)
Omalizumab (Xolair)
Mepolizumab (Nucala)
Benralizumab (Fasenra)
Dupilumab (Dupixent)
Prednisone
Azithromycin (low-dose COPD use)
CPAP (not a med, but underwriting flagged)
Endocrine & Metabolic
Type 1 diabetes
Type 2 diabetes
Thyroid disease
Addison’s, Cushing’s
Obesity
Endocrine & Metabolic Medications
Metformin
Glipizide
Glyburide
Glimepiride
Pioglitazone (Actos)
Rosiglitazone (Avandia)
Sitagliptin (Januvia)
Saxagliptin (Onglyza)
Linagliptin (Tradjenta)
Alogliptin (Nesina)
Exenatide (Byetta, Bydureon)
Liraglutide (Victoza)
Dulaglutide (Trulicity)
Semaglutide (Ozempic, Rybelsus)
Tirzepatide (Mounjaro)
Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)
Ertugliflozin (Steglatro)
Insulin Glargine (Lantus, Basaglar)
Insulin Detemir (Levemir)
Insulin Degludec (Tresiba)
Regular insulin (Humulin R, Novolin R)
NPH insulin
Insulin Lispro (Humalog)
Insulin Aspart (Novolog)
Levothyroxine (Synthroid)
Liothyronine (Cytomel)
Methimazole
Propylthiouracil (PTU)
Neurological
Epilepsy
Seizures
Parkinson’s disease
Multiple sclerosis (MS)
ALS (Lou Gehrig’s)
Cerebral palsy
Dementia / Alzheimer’s
Neuropathy
Neurological Medications
Levetiracetam (Keppra)
Lamotrigine (Lamictal)
Carbamazepine (Tegretol)
Oxcarbazepine (Trileptal)
Valproic Acid / Divalproex (Depakote)
Phenytoin (Dilantin)
Topiramate (Topamax)
Zonisamide (Zonegran)
Clonazepam (Klonopin)
Phenobarbital
Lacosamide (Vimpat)
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Primidone
Rufinamide
Cannabidiol (Epidiolex)
Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)
Memantine (Namenda)
Amantadine
Carbidopa/Levodopa (Sinemet)
Ropinirole (Requip)
Pramipexole (Mirapex)
Entacapone (Comtan)
Selegiline (Eldepryl)
Rasagiline (Azilect)
Ocrelizumab (Ocrevus)
Fingolimod (Gilenya)
Natalizumab (Tysabri)
Mental Health & Substance Use
Depression
Anxiety
Bipolar disorder
Schizophrenia
Suicide attempts
Alcohol abuse
Drug use (current or history)
Mental Health & Substance Use Medications
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram (Celexa)
Escitalopram (Lexapro)
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Bupropion (Wellbutrin)
Mirtazapine (Remeron)
Amitriptyline
Nortriptyline
Imipramine
Clomipramine
Lithium
Valproic Acid (Depakote)
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Aripiprazole (Abilify)
Risperidone (Risperdal)
Quetiapine (Seroquel)
Olanzapine (Zyprexa)
Clozapine (Clozaril)
Ziprasidone (Geodon)
Haloperidol (Haldol)
Chlorpromazine
Buspirone (Buspar)
Hydroxyzine (Atarax, Vistaril)
Naltrexone
Disulfiram (Antabuse)
Gastrointestinal & Liver
Hepatitis (A, B, C)
Cirrhosis
Fatty liver disease
Crohn’s disease
Ulcerative colitis
Gastrointestinal & Liver Medications
Interferon alfa
Ribavirin
Sofosbuvir (Sovaldi)
Ledipasvir/Sofosbuvir (Harvoni)
Velpatasvir/Sofosbuvir (Epclusa)
Glecaprevir/Pibrentasvir (Mavyret)
Tenofovir (Viread)
Entecavir (Baraclude)
Lamivudine
Adefovir
Ursodiol (Actigall)
Prednisone
Azathioprine (Imuran)
6-Mercaptopurine
Methotrexate
Infliximab (Remicade)
Adalimumab (Humira)
Certolizumab (Cimzia)
Golimumab (Simponi)
Vedolizumab (Entyvio)
Ustekinumab (Stelara)
Budesonide (Entocort, Uceris)
Mesalamine (Asacol, Lialda, Pentasa)
Sulfasalazine
Omeprazole
Pantoprazole
Lansoprazole
Esomeprazole
Famotidine
Sucralfate
Renal (Kidneys & Urinary)
Kidney disease (CKD)
Dialysis
Transplant
Kidney stones
Polycystic kidney disease
Renal (Kidneys & Urinary) Medications
Epoetin alfa (Epogen, Procrit)
Darbepoetin (Aranesp)
Sevelamer (Renvela)
Calcium acetate (PhosLo)
Lanthanum (Fosrenol)
Sodium zirconium cyclosilicate (Lokelma)
Patiromer (Veltassa)
Furosemide (Lasix)
Bumetanide
Torsemide
Hydrochlorothiazide
Spironolactone
Kayexalate
Iron supplements (Ferrous sulfate)
IV Iron (Venofer, Ferrlecit)
Cinacalcet (Sensipar)
Calcitriol
Ergocalciferol (Vitamin D2)
Paricalcitol
Prednisone (transplant rejection prevention)
Tacrolimus (Prograf)
Cyclosporine
Mycophenolate mofetil (CellCept)
Azathioprine
Sirolimus
Belatacept
ACE inhibitors (Lisinopril, Enalapril)
ARBs (Losartan, Valsartan)
Sodium bicarbonate
Allopurinol
Musculoskeletal & Autoimmune
Impairments
Lupus
Rheumatoid arthritis
Fibromyalgia
Psoriatic arthritis
Scoliosis
Follow-Ups
Date of diagnosis?
Current severity and limitations?
Medications (steroids, biologics)?
Organ involvement?
Common Medications (30)
Prednisone
Methylprednisolone
Hydrocortisone
Dexamethasone
Methotrexate
Leflunomide (Arava)
Hydroxychloroquine (Plaquenil)
Sulfasalazine
Mycophenolate
Cyclophosphamide
Tacrolimus
Etanercept (Enbrel)
Adalimumab (Humira)
Infliximab (Remicade)
Golimumab (Simponi)
Certolizumab (Cimzia)
Tocilizumab (Actemra)
Sarilumab (Kevzara)
Abatacept (Orencia)
Rituximab (Rituxan)
Belimumab (Benlysta)
Anifrolumab (Saphnelo)
NSAIDs (Ibuprofen, Naproxen)
Celecoxib (Celebrex)
Diclofenac
Gabapentin
Pregabalin (Lyrica)
Duloxetine (Cymbalta)
Infectious Diseases
HIV/AIDS
Chronic infections
Infectious Diseases Medications
Tenofovir
Emtricitabine
Lamivudine
Abacavir
Zidovudine
Stavudine
Didanosine
Efavirenz
Nevirapine
Etravirine
Rilpivirine
Atazanavir
Darunavir
Lopinavir/Ritonavir (Kaletra)
Indinavir
Saquinavir
Fosamprenavir
Dolutegravir
Raltegravir
Elvitegravir
Bictegravir
Maraviroc
Enfuvirtide
Descovy (Tenofovir/Emtricitabine)
Truvada
Biktarvy
Triumeq
Odefsey
Juluca
Symtuza
Other Conditions
Anemia
Bleeding disorders
Clotting disorders (DVT, PE)
Organ transplant
Congenital disorders
Additonal Medications
Warfarin
Eliquis (Apixaban)
Xarelto (Rivaroxaban)
Pradaxa (Dabigatran)
Heparin
Enoxaparin (Lovenox)
Fondaparinux (Arixtra)
Aspirin
Clopidogrel (Plavix)
Ticagrelor (Brilinta)
Prasugrel (Effient)
Hydroxyurea
Epoetin alfa
Darbepoetin
Iron (Ferrous sulfate)
IV Iron (Venofer)
Tranexamic acid
Aminocaproic acid
Desmopressin (DDAVP)
Factor VIII concentrate
Factor IX concentrate
Fibrinogen concentrate
Cryoprecipitate
Fresh frozen plasma (FFP)
Prednisone (autoimmune anemia)
Azathioprine
Rituximab
Cyclophosphamide
Mycophenolate
Stem cell transplant (not drug but flagged)
Send
bottom of page
