Arizona Health Insurance and Health Insurance throughout

 US

 

800-799-2893 

623-780-0077

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We compare plans and prices with several different insurance companies

based on your request.

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*First Name:

 *Last Name:
 

*City:

*Zip:

State:

 

 

 

*Phone:

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Are you currently covered by insurance?    

If yes, Who?

   
Applicant * Gender:    Age 
   
*Height     *Weight      

 

 

         

Spouse*

If spouse is to be added to quote

Spouse Included:       Gender: 

Age:

Height Weight     

Maternity coverage requested?

Requesting Children Coverage:  If yes, how many dependents:

For dependent quotes; Please provide for each

Age and Gender

 

Any Medical Conditions or Medications?

(i.e.  Asthma, Cancer, Diabetes, High Blood Pressure,  Pregnancy, etc.)

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IMPORTANT NOTICES AND DISCLAIMERS
PPO Plans DO NOT cover maternity    
*Subject to Deductible/Coinsurance, In addition to applicable deductible and coinsurance, noncontracted providers may charge members for the difference between their bill charges and carrier's allowed amount. 
This obligation to pay the difference between the providers bill charges and carrier's allowed amount continues after member's out of pocket maximum is met.
Rates are subject to change.  Attached forms/spread sheets are for illustration purposes only.  Please refer to insurance carrier contract for specific details. The policy certificate is the governing document. 
Each applicant is individual underwritten by carrier and may be declined / waived based on carrier guidelines.
THE APPLICATION IS NOT AN OFFER OF COVERAGE AND SUBMISSION OF YOUR APPLICATION DOES NOT GUARANTEE THAT YOU WILL RECEIVE COVERAGE. 
DO NOT CANCEL ANY HEALTH INSURANCE COVERAGE YOU CURRENTLY HAVE OR DECLINE COBRA BENEFITS UNTIL: 1. YOUR APPLICATION IS RECEIVED, REVIEWED, AND ACCEPTED BY CARRIER AND AN EFFECTIVE DATE OF COVERAGE IS ASSIGNED AND 2. YOUR COMPLETE AND CORRECT PAYMENT IS RECEIVED.

DISCLAIMER: Rates are based on medical conditions, demographics, etc.  This quote does not guarantee carrier approval.  All applicants are individual underwritten by the carriers. Any  supporting details to medical conditions, will assist in the quoting process. Pre-existing conditions may not be covered unless fully disclosed. Quote rates may change and/or vary. Any information collected through this website will not be resold to a third party, and is considered the confidential information of the party requesting rate and quote information.

 

 

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