For a health insurance quote, please click on the email link below and enter the following information.
You can copy this block of questions and then paste it into the email you will be sending to us. Be sure to fill in
the requested information.
Name of primary insured:
Date of birth of each person to be covered:
Genders of each person to be covered:
Smoker or non-smoker if each person to be covered:
Your city and Zip code:
Rate your (your family's/group's overall) health (Excellent, Good/Average, Poor):
Height:
Weight:
Type of coverage - Individual, Family, or Group:
Type
of insurance (i.e. traditional HMO or PPO style, or High Deductible/Health Savings Account):
Deductible (i.e.
$250, $500, $1,000, $2,500, $5,000): $
Office Visit Waiver (you pay your doctor a copay, of say, $20 and the
insurance company pays the rest) - Yes or No:
Prescription drug card? - Yes or No:
How do
you prefer to be contacted? email, phone, mail, etc.