Wednesday, March 10, 2010

Apply for a Florida Health Plan Quote

Florida Health Plans can match you with insurance professionals from our nationwide network who can provide you with accurate health insurance quotes. Simply provide some information about yourself and your family. This information will be used to match you with up to four agents who will contact you by phone to compare plans and help you choose the policy that best fits your needs. Get started now!

Step 1: Please Complete a General Medical Profile

Gender

Date of Birth
(MM / DD / YYYY)

Height

Weight
(lbs)

Smoker?

Full-time College Student?

Applicant*

/ /

Spouse

/ /

Children

What is this?

Child 1

/ /

Child 2

/ /

Child 3

/ /

Child 4

/ /

Child 5

/ /

Are you currently insured?*

yes no

If yes, who is your current insurance company?

When would you like coverage to begin?*

/ /

Do you currently take any medications?*

yes no

Please specify: *

Do any of the people applying for health insurance have any pre-existing health conditions?*

yes no

Step 2: Provide Your Contact Information
First Name*		Last Name*
Address*		City*
State*		Zip Code*
Day Phone*	- -	Evening Phone*	- -
Best Time to Contact*		Email Address*

I would like to receive your newsletter.
I have read and agree to the Privacy Policy and the Site Terms of Use. I understand that in order to receive comparison quotes I may be contacted by phone by up to five health insurance agents. Please read and agree to the Privacy Policy and Site Terms of Use.

Apply for a Florida Health Plan Quote

Step 1: Please Complete a General Medical Profile

Step 2: Provide Your Contact Information