To obtain an accurate quote, please tell us about yourself

You and Your Spouse (if applicable)

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(Have used tobacco products an average of 4 or more times per week within the past 6 months)
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Select "Covered" for Spouse Age if spouse has Medicare, VA coverage, Employee Only group coverage or other Valid Waiver. Select Age 64 for a spouse 65 or older who is certified not eligible for Medicare by Social Security.

Number of Dependent Children Under Age 21

Include All Dependent Children in Each Age Range

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Ages of Dependent Children Under Age 21

Enter Only the First Three Dependent Children in Order from Oldest to Youngest

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  • Select 1 for children age 1 or under.
  • Select N/A for each child already having insurance coverage under a child support court order, Medicaid or for any valid reason, but be sure to include these children in the number of dependent children above.
  • In the event of triplets, call for a quote.

Young Adult Dependents

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Ages of Adult Dependents Ages 21-25

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Identified as Bronze, Silver, Gold and Platinum - Catastrophic Plans are for up to Age 30 or Exempt Individuals Only

Please only provide this information if you are interested in subsidy eligibility for plans sold inside the state based Exchange