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What type of Health Insurance plan are you looking for?
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Have you used tobacco products within the last 12 months?

Important Tip: As a non-smoker you may qualify for our affordable rates (if no to smoker, if yes “Affordable Health Options for Smokers”)

Are you looking to include your spouse in your Health Insurance plan?
What is your spouse's gender?
Has your spouse used tobacco products within the last 12 months?
Are you looking to include your children in your Health Insurance plan?
Do any applicants weigh over 325 lbs if male, or over 275 lbs if female?
Do any applicants have any pre-existing conditions or been treated for any major medical conditions within the past 5 years?
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