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Individual Health/Life Insurance

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Our company is concerned with finding the best health and life solutions and rates for individuals, families and groups who need health insurance or life insurance.

 

Health Insurance Plans

 

     PPO Health Insurance

     Health Savings Accounts and High Deductible HSA Health Plans (formerly MSA)

     Short Term Medical Insurance Products

     Travel Medical Insurance and International Health Insurance

     Health Insurance Quotes for Non-US Citizens

     Small Business Group Health Insurance and Other Group Insurance

 

Life Insurance Plans

 

     Term Life Insurance

     Whole Life Insurance

     Universal Life Insurance

     Small Business Group Life Insurance

 

Current health and life insurance plans, including temporary health (short term medical), term life insurance, travel medical insurance (international health insurance), and long term care insurance, can each be evaluated for a client's personal need.

We offer individual health insurance and life insurance products for people with chronic medical conditions or notable pre-existing conditions. Individual insurance plans can be found for those who were once uninsurable.  

 

Insurance companies are continually creating new insurance options. Recent additions include short term medical insurance (temporary health insurance), international health insurance (travel medical insurance) and long term care insurance. We use our knowledge and experience to find the best policy to fit your needs

 

  *Please Provide as much information as possible to assure the most accurate quotes.  Leave blank if you are not sure of an answer.

  *See our Privacy policy for confidentiality.

     General Information

 

Name:

Phone:

E-mail Address:

Address:

 

City:

 

   State:    Zip:

     Current/Previous Insurance Information

Current Insurance Company:

 

Describe Your Current Health Plan:

Policy Period:

 Effective Date:    Expiration Date:

     Benefits Information

Deductible:

$

Quote PPO:

No  Yes

Doctor's Copay:

$

Quote HMO:

No  Yes

Drug Copay:

$

Quote POS

No  Yes

   

Quote Maternity Coverage:

No  Yes

     Individual/Family Information

 

 

You

Your Spouse

Child 1

Child 2

Child 3

Date of Birth:

Sex:

Occupation:

Approximate Height:

Approximate Weight:

lbs

lbs

lbs

lbs

lbs

Anyone listed had these  Conditions:

 

  Heart

  Cancer

  Diabetes

  Heart

  Cancer

  Diabetes

  Heart

  Cancer

  Diabetes

  Heart

  Cancer

  Diabetes

  Heart

  Cancer

  Diabetes

Optional Term Life:  $  $  $  $  $
Disability income: No  Yes No  Yes      
Long Term Care: No  Yes No  Yes      

     Health History Information

You:

 

 

 

Please list all prescription medications being taken and disclose all previous health conditions you currently have or have had in the past 5 years:

Your Spouse:

 

 

 

Please list all prescription medications being taken and disclose all previous health conditions you currently have or have had in the past 5 years:

Child 1:

 

 

 

Please list all prescription medications being taken and disclose all previous health conditions you currently have or have had in the past 5 years:

Child 2:

 

 

 

Please list all prescription medications being taken and disclose all previous health conditions you currently have or have had in the past 5 years:

Child 3:

 

 

 

Please list all prescription medications being taken and disclose all previous health conditions you currently have or have had in the past 5 years:

     Additional Comments & Information

Please tell us anything else you think might be helpful to know in order to provide accurate insurance quotes:

 

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