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(Temporary Health Insurance) for Short-Term Situations You may need temporary or short term health insurance in many different situations: just out of school, between jobs, not yet eligible for new employer’s coverage, temporary employee, early retirement, and after COBRA coverage ends. Is Short-Term Health Insurance expensive? Short term health insurance for healthy people is fairly low in cost. You also have a wide range of options from which to choose, from very basic coverage to almost total comprehensive. Some people only buy insurance that will help when medical problems are catastrophic in nature. Most people go with temporary insurance that covers most options and lasts from three to 12 months. Get a quote for short term plans now.>> How does having Short-Term Insurance affect me? You will have freedom of choice for the doctors and hospitals you use and may have a fairly low deductible. The insurance works like most other health insurance policies, covering hospital care, emergencies, surgery, bloodwork, x-rays and more. But if you have a pre-existing condition, you may be denied coverage. This is how the insurance companies keep the cost of these short term policies so low. Disadvantages of Temporary Health Insurance There are several disadvantages to temporary insurance. You may need pre-certification for many medical services. You need to make sure the deductible is payable only once and is not required for each illness or accident. Also, your use of the insurance for an accident or illness may be cited as a pre-existing condition when applying for another temporary policy, resulting in denial of more insurance.

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Street Address:
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Zip Code:
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E-Mail again for accuracy:
Phone (in case we need more info.):
Fax (optional):
 
If you Currently have Health Insurance or COBRA in force, when will it end?

UNDERWRITING INFORMATION
 
Insured Name: Sex (M/F): Birthdate:
Spouse Name: Sex (M/F): Birthdate:
Include Spouse?: Yes No Include    
Children?:		 Yes No
List children's names
& birthdates to be covered:
(up to 6 children)		 Name:B-Date:Sex:
Name:B-Date: Sex:
Name:B-Date: Sex:
Name:B-Date: Sex:
Name:B-Date: Sex:
Name:B-Date: Sex:
Be as specific as you can on the underwriting questions below so we may find the most competitive product for you!
Do You use tobacco? Yes No Describe usage (cigar, cigarettes, etc.)
 
Any Pre-existing Health Conditions?
 (If yes, descibe in detail, and to which of the insured persons they apply.)
 
Any Covered Persons Currently Taking Medication of Any Kind?
 (If yes, descibe in detail, and to which of the insured persons they apply.)

COVERAGE INFORMATION
 
How Long Do You Need Coverage For?
(if short term, etc.)
 
What deductible are you interested in (if none selected all will be quoted)
($250, $500, $1000, $2500, etc.):
 
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