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Temporary health insurance is a perfect solution for individuals needing insurance in the short term, whether they are uninsured, unemployed, self-employed or just need an affordable insurance product that fits their monthly budget.
Temporary health insurance is a perfect solution for individuals needing insurance in the short term, whether they are uninsured, unemployed, self-employed or just need an affordable insurance product that fits their monthly budget. read more...

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Our Products

  • Short Term Insurance
  • Short term health insurance coverage for up to 12 months
  • Low cost and nationwide PPO network
  • Coverage can start as soon as you are approved
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  • Dental Insurance
  • Coverage for routine visits and major dental work
  • Large nationwide network of dentists
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Effective Date

Per the HHS rule governing short term limited duration coverage, short term medical policy purchases are limited to a maximum duration of 90 days. You may be eligible to apply for a new policy after your current policy expires (subject to regulations in certain States).

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    If you need to modify birth date, gender, relationship, tobacco usage or add another person, click here. Modifications could result in a change in pricing of the quote.


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    Eligibility Questions

    Please answer the following medical questions for all individuals, including dependents, applying for coverage

    Please be aware that any misstatements and omissions may be a material misrepresentation and a basis for rescission of your coverage. In the event of a rescission; (1) coverage will be void as of the Effective Date; (2) all premiums paid will be refunded; (3) any claims that have been submitted will be denied; (4) if any claims have been paid, the amount of claims paid will be deducted from any premium refund due.

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    Please check if you have answered the above questions.

    Short Term Medical

    I hereby apply for the coverage selected on this application form. I understand that the coverage shall not become effective until this application is accepted by the insurer and the initial premium is paid. I read this application carefully and represent that the information I provided is true, correct and complete. I understand that the insurer relied on my statements and my answers to the medical history questions and it is the basis for determining the issuance or denial of coverage. I understand that any misstatement or omission may result in the denial of benefits and/or the termination of coverage.
    I agree and understand that coverage will not become effective for any applicant whose medical history changes prior to that person’s Effective Date such that the applicant’s answer would be “yes” to any of the medical history questions in this application and agree to immediately notify the insurer of any such changes. If such person is the Applicant, I understand that coverage is automatically declined for all persons applying on this application.
    I understand that health insurance benefits are excluded for pre-existing conditions and this coverage will not pay benefits for a disease or physical condition that I or another applicant may now have or have had within 5 years of the application for coverage.
    I understand that the producer who solicited this application and upon whose explanation of the benefits, limitations or exclusions I relied on was retained by me as my agent and is an independent contractor who has no right to alter the application, bind or approve coverage or alter any of the terms or conditions of the policy.
    I understand that cancellation of this coverage within the 10 day right to return the policy period will result in a refund of premiums only. Any administrative fees or other fees that may apply will not be refunded.
    I understand that this coverage for which I am applying is not Minimum Essential Coverage as defined by the Affordable Care Act of 2010 (ACA). Even if I have this coverage, I still may be subject to the federal tax assessed against individuals without Minimum Essential Coverage.

    AUTHORIZATION TO RELEASE INFORMATION: I authorize any health care provider, doctor, medical professional, medical facility, insurance company, pharmacy benefit manager, person or organization to release any information regarding medical, dental, mental, alcohol or drug abuse history, treatment or benefits payable, including disability of employment related information concerning the patient, excluding genetic information, to the insurer or its administrator.

    Applicants under the age of 18 must have a Parent/Guardian signature
    You agree and consent the use of a key pad, mouse or other device to select an item, button, icon or similar act/action while using this website; or in accessing or making any transactions regarding this application constitutes your signature, acceptance, and agreement as if actually signed by you in writing. Further, you agree no certification authority or other third party verification is necessary to the validity of your electronic signature; and the lack of such certification or third party verification will not in any way affect the enforceability of your signature or the resulting contract. You warrant that all the information you have provided is true, complete and accurate.
    Please note:
    • Any electronic document bearing a user’s e-signature will be considered "in writing" and "wet-signed".
    • Any user e-signed document shall be deemed to be an “original” document when printed and used in the normal course of business.
    • Absent manifest error, the admissibility, validity, or use of any e-signed electronic document cannot be contested.

    Short Term Medical

    Fraud Warning:
    Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement, or conceals information for the purpose of misleading may be guilty of insurance fraud and subject to criminal and/or civil penalty.

    Review and Acknowledge

    Please verify that you accept and understand the terms and disclaimers below, and complete the electronic signature.

    You're almost done,

    All you need to do now is electronically sign your application and you're done! Type your name below to electronically sign your application:

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    eSignature and Submission

    It is important that you carefully read and fully understand the following.

    Type your name below to electronically sign your application
    Please check your typed name to make sure they are correct
    This is the information that we will include on your application to pay your first month’s premium directly to your insurance carrier.

    Are you rewriting an existing National General Short Term Medical customer on a new National General Short Term Medical plan? This applies to National General Rewrites only.

    Payment Summary

    If applicable, premium will be debited immediately following receipt of the form.

    Billing Authorization The accountholder of the bank account or credit card provided during this enrollment process authorizes and requests the Insurer to initiate automatic electronic payments against such indicated bank account or credit card for the payment of premiums and other indicated monthly dues included in the plan(s) being purchased during this enrollment process. Accountholder agrees that the electronic payment authorization for such automatic payments may be terminated by providing written notice to the Insurer.

    Billing Info

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    Thank you for completing your application!
    We've emailed you a confirmation email for your records. Our agents will process your application and within 5-15 days your plan information & premium bill will be mailed to you by the insurance carrier, or in some cases, you will be able to pay your bill online.
    Click here to review your application. If additional information is required, an agent or the insurance carrier may reach out to you to complete your application.
    Thank you for choosing Illinois Health Agents!

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    3501 N Southport Ave
    Chicago, IL 60657