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Do
you have health insurance
now? |
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If
Yes, Why do you want to
change? |
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Please
select Health Plan
Deductible Preference(s) |
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If
you selected
"Medicare
Supplement" above,
please indicate the Plan
in which you have
interest. (Plans A thru J
or Other). |
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| For
those interested in
opening a Health Savings
Account, the purchase of
an HSA Health Plan is
mandatory to meet
eligibility requirements
(* This quoting option is
for HSA Health Plans
Only).
The current possibilities
as the law permits are outlined
below: |
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| *Note:
Total out-of-pocket expenses are
limited to no more than $3,100
on Individual Plans and $5,700
on Family Plans, assuming the
insured's charges fall within
eligible expense categories. |
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| For
all of those to be covered,
please list any pre-existing
conditions, prescription
medications currently being
taken and hospitalizations within
the past 5 years. |
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