Health Insurance Pre-Screen Application

If you are applying for individual health insurance coverage, a pre-existing condition can impact on the rates quoted by health insurance carriers and can even result in a decline if you apply to the wrong insurance company. Let us provide you some support and prequalify you for the best health plan before you apply. We have experience working with clients and carriers and if we are not sure we can discuss it with underwriters prior to submitting your application and save you a lot of unnesessary grief.

The pre-screen is provided for informational purpose only and is not intended as health insurance underwriting. We use the information you provide to determine which healthcare plan may be right for you prior to application.  This response form is not binding on any insurance company and is based only on the information received by you. Upon receipt and review of the application, the underwriting decision of a carrier may differ from the initial response.

 

Contact Information
First Name:
Last Name:
Email Address:
 *
State:
 *
Zip Code:
Applicant Information
Gender
Age
 *
Height Ft
Height Inches
Weight Lbs
 *
Smoker:
Medical Information:
Diagnosis
 *
Medications
 *
Dosage per Day:
 *
Details
 *
Comment
Contact Phone:
 *
Do not enter anything in this field:
* indicates a required field

 
 
The Power Of Numbers


 

 


Trinity 1 Financial Group Tol Free Phone & EFax: 1-866-684-Quote( 7868) Email: chris@trinity1fn.com
© Copyright Trinity 1 Financial Group
Florida Life & Health Insurance  Georgia Life & Health Insurance  California Life & Health Insurance Texas Life & Health Insurance Pennsylvania Life & Health Insurance Ohio Life & Health Insurance Montana Life & Health Insurance

 

 


Site Powered By
    Virtual Biz Builder
    Online Website Builder