Health Insurance Care Tips

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Here are tips to help you get the best care for you and your family:

Stay Informed

Read your health insurance policy and member handbook. Make sure you understand them, especially the information on benefits, coverage, and limits. Sales materials or plan summaries cannot give you the full picture.
See if your plan has a magazine or newsletter. It can be a good source of information on how the plan works and on important policies that affect your care.
Talk to your health benefits officer at work to learn more about your policy.
Ask how the plan will notify you of changes in the network of providers

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Primary Applicant Information:
Gender	Birthdate	Height	Weight	Tobacco?

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How many children would you like to cover?

Is anyone to be included in this quote pregnant? *	Yes No
Does anyone to be included currently have health insurance? *	Yes No

Does anyone to be covered have any major health conditions? *

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Primary Applicant's Occupation: (If full-time student, write "student")
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	Gender	Birthdate	Height	Weight
Child 1 Information:

If any person applying has any of the following conditions, please check the corresponding box:
AIDS / HIV	Alcohol / Drug Abuse	Alzheimer's / Dementia
Asthma	Cancer	Clinical Depression
Diabetes	Emphysema	Epilepsy
Heart Attack	Heart Disease	Hepatitis / Liver
High Blood Pressure	High Cholesterol	Kidney Disease
Mental Illness	Multiple Sclerosis	Pulmonary Disease
Stroke	Ulcers	Vascular Disease
Other / Not Listed	If other, please list conditions:


First Name *		Last Name *
Address *		City *
State *		Zip Code *
Day Phone *		Evening Phone
Email *