Affordable Term Life Insurance Quote

	Affordable Term Life Insurance
	"The Best Low Cost Quotes, Online"

Tell a Friend \| En Español

Individual

Let LM Financial Help


	We're Waiting For Your Call 1-800-748-5538


	Now choosing a health insurance plan is easier than ever. You can choose the plan that both provides your benefit needs and stays within your budget. For most people, this means deciding which plan is most affordable for the benefits you need. For example, plans that provide a greater choice of doctors, hospitals and benefits tend to cost more than plans that limit these choices. HMO (Health Maintenance Organization) - Requires you to obtain medical care from a specified list of hospitals and doctors. You must choose a PCP (Primary Care Physician) and you need a referral from your PCP to see Specialists. Out of network expenses are not covered. POS (Point-of-Service) - Also requires you to obtain medical care from a specified list of hospitals and doctors as well as Primary Care Physicians. However, you also have the option to obtain care from non-network doctors and hospitals. When your expenses are from out-of-network providers, you will have to pay more of the cost. PPO (Preferred Provider Organization) - Allows you to use specified in-network hospitals and doctors, but you can also use out of network hospitals and doctors who are not members of the PPO network. If you are seen by PPO providers, your benefit will be at a higher return than if you were seen by an out of network provider. Unlike a POS, you do not have to choose a PCP (Primary Care Physician) in order to receive In Network benefits.


	Individual Health Insurance Quote Form

Contact Information

Name:

Address:

City:

State: Zip:

Phone:

Work:

Home:

Fax:

Email:

Personal Information

Date of Birth:

/ /

Gender:

Male Female

Weight:

Height:

Occupation:

Tobacco Use in Past 12 Months:

Yes No

Spouse and Children Information ( If they are included )

Name	Relation	Gender	Date of Birth	Height	Weight

Health Information

In Last 10 years, has any person to be covered received medical or surgical consultation, advice or treatment (including medication) for any of the following:

Yes No

Stroke, heart or circulatory system disorders, liver disorders, kidney diseases, emphysema, rheumatoid arthritis, ulcerative colitis, diabetes, cancer, alcohol/drug abuse, immune system disorders (including HIV infection) or tested positive for HIV infection?

If Yes, Give Details:

Do you have high blood pressure?

Yes No

Is any family member(whether or not to be covered) an expectant mother or father?

Yes No

Select Health Plans and Options

Please select the type of plans and options you would like to receive quotes on

Plans

Options

HMO

Maternity

PPO Medical

Prescription

Indemnity Plans

Dental

Vision Care

HMO(Health Maintenance Organization) - Requires you to obtain medical care from a specified list of hospitals and doctors. You must choose a PCP (Primary Care Physician) and you need a referral from your PCP to see Specialists. Out of network expenses are not covered.

PPO(Preferred Provider Organization) - Allows you to use specified in-network hospitals and doctors but you can also use out of network hospitals and doctors who are not members of the PPO network. If you are seen by PPO providers your benefit will be at a higher return than if you were seen by an out of network provider. Unlike a POS, you do not have to choose a PCP (Primary Care Physician) in order to receive In Network benefits.

INDEMNITY PLANS - allow you to use any doctor or hospital. This type of plan will pay covered expenses on what is known as a reasonable and customary basis. Typically all expenses are subject to a deductible ($250), and coinsurance (80%).


	Remember: LM Financial & Insurance Services are also your partners for Affordable Term Life Insurance!


Let LM Financial Help	Top of Page

Why it pays to let LM Financial help you find
the best, most affordable health insurance

We will contact you promptly.
We will never sell your personal information to anyone.
Our computerized quote database accurately determines the coverage you qualify for.
You will get quotes from several highly-rated insurance companies, to make sure you get the best coverage at the best price.
We will assist you in getting your life insurance policy issued quickly and efficiently.We are committed to providing excellent customer service and the best term life insurance.

Affordable Term Life Insurance

"The Best Low Cost Quotes, Online"

Individual