AGLAchoice® Guarantee Plus: Permanent, Guaranteed Universal Life Insurance* - with the CustomerChoiceSM Lifestyle Income Rider AGLAchoice® Guarantee Plus is Universal Life coverage that is designed to help meet ongoing, permanent financial security needs. It offers customers guaranteed life insurance protection at an affordable premium. Yet this product also helps to protect against outliving your retirement income with the CustomerChoiceSM Lifestyle Income Rider. This rider was developed to help Americans preserve their standard of living. It provides the option to receive a living benefit to help supplement your retirement income. AGLAchoice® Guarantee Plus is part of the Quality of Life…Insurance®suite of products, so in addition to safe and stable life insurance protection, it also offers living benefits through the Accelerated Benefit Rider(s). This innovative rider can help with the costs of critical or long-term chronic illnesses or conditions while you are still alive. AGLAchoice®Guarantee Plus with the CustomerChoiceSM Lifestyle Income Rider is life insurance you don’t have to die to use. Guarantees are subject to the claims-paying ability of the issuing insurance company. Download our consumer brochure to learn more about AGLAchoice®Guarantee Plus with the CustomerChoiceSM Lifestyle Income Rider. AGLAchoice® Guarantee Plus : Permanent, Guaranteed Universal Life Insurance* with the CustomerChoiceSM Lifestyle Income Rider (Not available in all states) Please complete the information below to have an agent contact you concerning AGLAchoice® Guarantee Plus. CONTACT INFORMATION * First Name: * E-mail: * Last Name: * Phone: * City: * State: * Zip: --None-- ALABAMA ARKANSAS ARIZONA CALIFORNIA COLORADO CONNECTICUT DC DELAWARE FLORIDA GEORGIA HAWAII HOME OFFICE IOWA IDAHO ILLINOIS INDIANA KANSAS KENTUCKY LOUISIANA MASSACHUSETTS MARYLAND MAINE MICHIGAN MINNESOTA MISSOURI MISSISSIPPI MONTANA NORTH CAROLINA NORTH DAKOTA NEBRASKA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEVADA NEW YORK OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VIRGINIA VERMONT WASHINGTON WISCONSIN WEST VIRGINIA WYOMING How did you hear about us: --Please Select-- Friend Internet Ad Mailing Other Print Ad Relative Commercial NFIB NDA *Rider names and availability varies by state. NOTE: This form uses SSL security to encrypt the data that you submit using the form. Although your browser may not display the designated security symbol, if you right-click on the form and view its properties, you will see that it is, in fact, secure. Our reply by e-mail may not be encrypted or completely secure. If other individuals or entities have access to your e-mail or your computer, they may also have access to the response to your e-mail. If you click the "Submit" button or submit this electronic inquiry in any other manner, you hereby authorize us to reply to your inquiry by e-mail. User acknowledges and agrees that by providing American General Life Insurance Company with any personal or confidential user information through this e-mail function, user consents to the transmission (including the sending and reply) of such personal or confidential user information through the public Internet and via e-mail, and understands that there are risks that this information could be viewed by other parties. User agrees to adhere to procedures that may be established by American General Life Insurance Company to enhance the safety and confidentiality of transmissions of personal data over the Internet.

Important Consumer Disclosures Regarding Accelerated Benefit Riders

Disclosures Applicable to the Accelerated Benefit Rider

(1) When filing a claim for Qualifying Critical Illness or Qualifying Chronic Illness under an Accelerated Benefit Rider, the claimant must provide to the Company a completed claim form which must be received at its Home Office within the time frame specified in the Rider.

(2) If a benefit under an Accelerated Benefit Rider is payable, the Company will provide the Owner with one (1) opportunity to elect a Flexible Accelerated Benefit under a Policy. The Owner must complete an election form and return it to AGLA within 60 days of receipt of the election form.  The Company will not provide a later opportunity to elect a Flexible Accelerated Benefit under a Policy as to the same Qualifying Critical Illness or Qualifying Chronic Illness.

Disclosures Applicable to the Critical Illness Accelerated Benefit Rider, Chronic Illness Accelerated Benefit Rider, and Terminal Illness Accelerated Benefit Rider

(1) When filing a claim under a Critical Illness Accelerated Benefit Rider, the claimant must provide the Company a completed claim form within 365 days of the required Diagnosis by a Physician of an Insured Person’s Critical Illness. 

(2)When filing a claim under a Chronic Illness Accelerated Benefit Rider, the claimant must provide the Company a completed claim form within 365 days of the required Certification by a Licensed Health Care Practitioner of an Insured Person’s Chronic Illness.

(3) If a benefit under an accelerated benefit rider is payable, the Company will provide the Owner with one (1) opportunity to elect an Accelerated Benefit under a Policy. The Owner must complete an election form and return it to AGLA within 60 days of receipt of the election form.  The Company will not provide a later opportunity to elect an Accelerated Benefit under a Policy as to the same Critical Illness or Chronic Illness.

Disclosures Applicable to the Accelerated Benefit Rider and to the Critical Illness Accelerated Benefit Rider, Chronic Illness Accelerated Benefit Rider, and Terminal Illness Accelerated Benefit Rider

(1) The failure to provide a required claim form and a required election form within the periods set forth for each in a Policy may preclude payment of a benefit.

(2) If you choose to receive an accelerated death benefit on account of a Chronic Illness or Terminal Illness, the sum included in Box 2 of the IRS Form 1099 LTC for “Accelerated death benefits paid” that you will receive will be the actual sum you received by check or otherwise, less any refund of premium or of loan interest that you received, plus any unpaid but due policy premium and, if applicable, a pro rata amount of any loan balance.

(3) Benefits payable under an accelerated benefit rider may be taxable. If so, you may incur a tax obligation. Neither American General Life Insurance Company, nor any agent representing it is authorized to give legal or tax advice. Please consult a qualified legal or tax advisor regarding questions concerning the information and concepts contained in this material.

(4) See your policy for details.

For Policy Forms AGLA 05AHO, AGLA 08174, AGLA 08ALO, AGLA 08TRM, AGLA 09TRM, ICC11 AGLA 11IUL, AGLA 11IUL, and Riders AGLA 07CHP, AGLA 05AHA REV0308, AGLA 05AHC, AGLA 05AHB, AGLA 05AHG, AGLA 05AHP,  AGLA 05AD2, AGLA 08MGP, AGLA EMD-DB, AGLA 04001, AGLA 05AD2,  AGLA 20140-1, AGLA PW-A-NL, ICC11 AGLA ICIAR, ICC11 AGLA PRIIAR, AGLA ICIIAR, AGLA PRIIAR, ICC10 AGLA ABR, AGLA ABR and state variations.

The underwriting risks, financial and contractual obligations and support functions associated with products issued by American General Life Insurance Company are its responsibility. American General Life Insurance Company does not solicit business in the state of New York.

Products issued by American General Life Insurance Company.
2727-A Allen Parkway
Houston, TX 77019

Product/Rider names, terms and definitions may also vary by state.

Please ask your American General Life Insurance Company agent for details.

Products/Riders are not available in all states.