| To apply for an Individual and Family
Plan, create an account, log
in, and get started anytime you´re ready or
get
a quote
Applying
online is simple and provides maximum flexibility
- begin the application and save it at any point in
the process to return later to complete it. When you´ve
completed your application you can come back and check
on its status anytime.
Create an account to apply for a plan or if you already
have an account, log
in
Before you get started, there are a few pieces
of information that you should collect to make sure
your application is thorough.
- Birth Date
- Social Security Number ( optional )
- Height and weight for each person
- Current and past health insurance plan information
- Medical history including dates of diagnosis, treatment,
service, and current status
- Prescription drug information including drug names,
dosages, and date initially prescribed
- Physician and/or treatment facility contact information
- Payment information for your first month’s premium
|
Printable
Application 
Online Application
