Health Quote
SELECTING A PLAN TYPE:
Use the statements below to help determine what plan type best meets your coverage needs.
 

I want more control over my health care and access to any doctor
or specialist I choose.

PPO PLAN

I need a lower monthly premium so I'm willing to pay more for my
health care services as they occur throughout the year.

PPO PLAN

I want to pay as little as possible when I see a doctor, so I'm willing
to select a specific medical group and physician to coordinate all of
my health care needs..

HMO PLAN

I'm willing to pay a higher premium up front so that my costs for health
care services are lower as the occur throughout the year.

HMO PLAN

Coverage Requested

* Our Ages

  My Age      Spouse's Age  
*People Covered
*Health Plan Choice
* Dental Plan Choice
                          

Customer Information
*Full Name
*E-mail
*Street Address
*City
*Zip Code
*Home Phone
* Work Phone
* Fax
 *Preferred Contact Time:

*Have you any comments or special instructions?
 
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