Individual Health

Thank you for your interest.

Medical coverage goes right to the heart of why we buy insurance in the first place. We buy insurance as a way to protect ourselves against loss. If you’ve ever had a major injury or surgery, you understand the importance of having good medical insurance.

After completing the form, please click on the “Submit” button. Your information will be emailed to our offices and we will process your request. All information will be kept confidential.

Please use the form below to contact us.







Contact Information

 
Name
Email
Phone
Address1
City
State
Zip

Tell Us About Yourself & Your Family

 
What’s your occupation?

Will the policy cover:

You
You and Your Spouse
You and Your Spouse and Children
Ages of children (if applicable):

Genders of children (if applicable):

Your Age:

Age of Spouse:

M/F

Male
Female
Are you a tobacco user?

Yes
No

Policy Considerations

 
What co-payment amount would you like to spend when visiting a doctor’s office?

What amount of hospital deductible is best for your policy?

What amount of coinsurance is best for your policy?

What types of optional coverage would you like included in the policy? (Check all that apply)

Maternity
Prescription Card
Supplemental Accident
Other
Would you like to learn more about the High-deductible Healthcare Spending Account (HSA)?

Yes
No