• Blue Zone Protection & Resilience Assessment

    Answer a few questions to understand your current coverage, goals, and potential gaps—no obligation to purchase.
  • Would spouse or partner income continue?
  • Would survivors face childcare, caregiving, or special-needs expenses?

  • EMPLOYER & OTHER PROTECTION

    Let’s start with you. What changed?
  • Is the employer/group life insurance portable if employment ends?
  • Is there accidental death coverage?
  • Is there short-term disability coverage?
  • Is there long-term disability coverage?
  • Is there an employer retirement plan?
  • Is there a pension?
  • Is there personally owned disability coverage?
  • Is there long-term-care coverage?
  • Welcome to the Blue Zone Family Protection Guide. Life changes, and sometimes the protection we put in place years ago doesn’t change with it. This guided assessment helps us understand what changed, who depends on you, what protection you already have, and what may deserve a closer look. We’ll consider four areas: dying too soon, becoming seriously ill, living longer than expected, and protecting what you’ve built. An estimate is enough for this initial review. There is no obligation to purchase anything. Estimates are fine, and ‘Not sure’ is an acceptable answer where offered.
  • Format: (000) 000-0000.
  • Do you currently have any life, disability, or critical illness insurance?*
  • Who do you want to protect financially? (Select all that apply)*
  • Which of these risks are you most concerned about?*
  • What is your primary goal for your family's financial protection?*
  • Do you feel your current protection is up to date with your life changes?*
  • Would you like to schedule a Complimentary Policy Review & Update?*
  • By submitting this form, I acknowledge that the information provided is preliminary and must be verified before any recommendation is made. Insurance illustrations may include guaranteed and non-guaranteed elements, underwriting and product availability apply, tax treatment depends on individual facts and current law, and legal, tax, and investment advice must come from appropriately qualified professionals.
  • Are you a business owner?
  • Do you currently have existing coverage?
  • Are you looking to replace or review a policy?
  • What type of life insurance policy do you have?
  • Which priority is most important?
  • Do you want to proceed to case assessment?
  • Is legacy or estate planning selected?
  • Do you want trust ownership?
    • EXISTING LIFE INSURANCE — POLICY REVIEW DETAILS 
    • PERMANENT / IUL FOLLOW-UP 
    • BUSINESS PROTECTION 
    • Are you self-employed?
    • Do you have any personally guaranteed business debt?
    • Do you have a buy-sell agreement?
    • When was the buy-sell agreement last reviewed?
       - -
      2 digit month, 2 digit day, 4 digit year
    • Is the buy-sell agreement funded?
    • Do you have key-person coverage?
    • Do you have a business succession plan?
    • Do you need attorney assistance?
    • Do you need CPA assistance?
    • Do you need business-valuation assistance?
    • This form does not provide legal, tax, or valuation advice. If you choose to share a current policy, annual statement, or in-force illustration, it can help make the review more accurate, but it is optional.
    • REPLACEMENT / EXCHANGE 
    • Do not cancel, reduce, borrow against, exchange, or otherwise alter existing coverage until any new coverage is approved, issued, and accepted, and until replacement consequences and applicable carrier and state requirements have been reviewed.
    • Which of these actions are you considering for your existing coverage? (Select all that apply)*
    • Could a surrender charge or other cost apply?*
    • Has your health changed since the current policy was issued?*
    • Should existing coverage remain in force during underwriting?*
    • CASE ASSESSMENT FOLLOW-UP 
    • TRUST / ESTATE FOLLOW-UP 
    • Are the owner and insured the same person?*
    • Is any beneficiary a minor or has special needs?*
    • Is a trust named or contemplated?*
    • Is the estate named as beneficiary?*
    • This assessment does not automatically recommend a product. Questions about legal ownership, trusts, estate structure, or tax treatment may require guidance from qualified legal or tax professionals.
    • Is business or entity ownership involved in this coverage?
    • Could divorce, remarriage, births, deaths, or other family changes affect current beneficiaries?
    • Has an attorney advised you on ownership, trust, or estate structure?
    • NEEDS ANALYSIS 
    • Which household obligations are non-negotiable if the client dies?*

    • LONGEVITY / RETIREMENT

      Now let’s consider retirement and longevity.
    • What are your expected retirement income sources? (Select all that apply)*
    • What retirement lifestyle or income range do you want?*
    • Are your essential retirement expenses expected to be covered by guaranteed income sources?*
    • How concerned are you about market losses near or during retirement?*
    • How concerned are you about outliving your assets?*
    • What is your desired legacy objective?*
    • What major retirement expenses do you anticipate? (Select all that apply)*
    • How important is liquidity and flexibility in retirement?*
    • FUNDING DURABILITY / AFFORDABILITY 
    • Would the contemplated long-term contribution remain sustainable if income temporarily falls?*
    • Which best describes the income used to fund this contribution?*
    • Are any major expenses expected in the next 1–5 years?*
    • How much premium flexibility is required?*
    • What circumstances would cause premiums to be reduced or stopped? (Select all that apply)*
    • Do emergency reserves and required household obligations take priority over long-term insurance funding?*

    • LIVING BENEFITS / HEALTH-EVENT NEEDS

    • Note: Rider definitions, qualifying events, availability, acceleration amounts, costs, and effects can vary by policy and carrier.
    • After a serious, chronic, critical, or terminal illness, which expenses would concern you most? (Select all that apply)*
    • Would another household earner need to reduce work to provide care?*
    • Do you understand any living-benefit riders already on existing policies?*

    • CLIENT OBJECTIVES & SUITABILITY

      Almost done—let’s identify what matters most.
    • Which objectives are most important to you? (Select all that apply)*
    • How comfortable are you with non-guaranteed outcomes?*
    • Would you like alternatives compared? (Select all that apply)*

    • REVIEW OUTCOME

      A licensed professional will verify the information you share and review alternatives before any recommendation is made.
    • Which next step best fits your situation?*
    • You may not need another policy. The goal is to understand whether the protection you already have still fits the life you’re building.
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