Be as specific as you can on the underwriting questions below so we may find the most competitive product for you!
Do You use tobacco?
Yes
No
Describe usage (cigar, cigarettes, etc.)
Any Pre-existing Health Conditions?
(If yes, descibe in detail, and to which of the insured persons they apply.)
Any Covered Persons Currently Taking Medication of Any Kind?
(If yes, descibe in detail, and to which of the insured persons they apply.)
COVERAGE INFORMATION
How Long Do You Need Coverage For? (if short term, etc.)
What Deductible Do You Want? ($250, $500, $1000, etc.):
Any special coverages needed? (Maternity, H.M.O., P.P.O., etc.)
Tell Us What You Want MOST in your Health Plan, or list any other Remarks here:
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