Please complete the following form and click Submit. We will call you as soon as possible to gather further information in order to provide you with the most accurate quote. Please be sure to provide a phone number where we can reach you within the next 24 hours. Thank you!

*We respect your right to personal privacy. To that end, we collect and use the information you provide to us for quoting purposes only.

The State Bar of California Sponsored Insurance Plans

Disability and Long Term Care Insurance
Are you requesting a quote for: * Long Term Care Disability BOTH
Member name*
Date of birth (mm/dd/yyyy)*
Spouses name
Spouses Date of birth (mm/dd/yyyy)
State* Zip*
Phone number*
Email address*
Approximate annual earned income
Current amount of in-force disability coverage:
How did you hear about us? *

Received postcard
Received letter
CalBar Website
State Bar



AI&PS is proud to be the sponsored provider of Disability Income Protection and Long Term Care Plans for the State Bar of California members since 1954.



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