Enter For a Chance To Win a $500 Subsidiary Card Just by Answering a Few Simple Questions!

Do You Have Medicaid? *

Do You Have Life Insurance?

Yes

Do You Need Life Insurance?

Yes

First Name *

Last Name *

Address

Street Address

City

State *

Country

Postal code

Date of birth *

Email *

By providing your email, we have a chance to notify you if your selected!

Phone *

Emails don't always go through – make sure we can reach you by providing your phone number. You may be notified if selected as a winner.

By entering your phone number and consenting, you agree to receive SMS notifications, alerts, and occasional marketing communications from Legacy Impact Benefits. Message frequency may vary, and message & data rates may apply. You may be contacted by an agent for further assistance or details. For help, text HELP to (714)-419-7934. You can reply STOP at any time to unsubscribe from future messages. However, please note that if you are selected as a winner and opt-out, you will no longer be eligible to receive the prize.

What is this survey for?

The survey helps us connect you with opportunities that could provide peace of mind for you and your family.

When will I know if I’ve won?

The winner will be announced on March 1st. Make sure your contact details are correct so we can notify you!