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What type of Health Insurance plan are you looking for?
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16%
What is your total household income?
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22%
Have you used tobacco products within the last 12 months?

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

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28%
Are you looking to include your spouse in your Health Insurance plan?
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34%
What is your spouse's gender?
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46%
Has your spouse used tobacco products within the last 12 months?
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52%
Are you looking to include your children in your Health Insurance plan?
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58%
Do any applicants weigh over 325 lbs if male, or over 275 lbs if female?
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64%
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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70%
What is your full name?
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80%
What is your email address?
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82%
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