Find Your Best Health Insurance Options Fast
Who needs to be covered by your policy?
Gender Date of Birth Height Weight Use Tobacco?
(OK to estimate) (OK to estimate) (in past 6 months)
Applicant
Female Male
/ /
5' 5"
Spouse
Female Male
/ /
Select
Child 1
Female Male
/ /
Select
Child 2
Female Male
/ /
Select
This information helps us identify which insurance companies may offer you the best policies.
Have any of the following events happened to you in the past 60 days?
Check all that apply.
This information helps us determine if you are eligible for government subsidies.
What is your household size and income?
Household size:
Yearly household income:
(OK to estimate)
This information helps us determine if you are eligible for government subsidies.
Does anyone you need to insure have any of the following medical conditions?
Check all that apply.
As of Jan. 1 2014: Health insurance plans can't refuse to cover you or charge you more just because you have a pre-existing health condition!
So why do we ask this question?
This information helps companies identify the policies that offer the most relevant benefits for certain conditions.
Finally, please provide the information below so insurance companies can provide you with free quotes!
First Name
Last Name
Street Address
NEW YORK,
NY
10103
Primary Phone
Email Address
All fields required