Individual Instant Rate Quote

Health Check Select Care and Children's Major Medical - health care coverage as individual as you are!

Meeting your individual and family insurance needs has never been easier.  For a personalized quote with no obligation, all you have to do is provide some basic information. The person applying for coverage must be an Oklahoma resident to be eligible for Health Check Select Care or Children’s Major Medical.

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Complete the form then click the "I accept" button to submit.
Individual Instant Quote Form Help
What is the home zip code of the person(s) applying for coverage?

To continue, please enter the following information for each person for whom you are requesting a quote.

Date of Birth mm/dd/ccyy Gender Tobacco User?* Maternity Coverage?**
Applicant Male Female Yes       Yes
Spouse      Male Female Yes       Yes
* Has this person used tobacco in any form in the past 12 months?
** Maternity coverage is not available to applicants under age 19.
Number of unmarried dependents under age 19
0 1  2  3 or more

Important Information About Your Quote
The rates shown are based upon the information contained in the quote request submitted. The final rates may vary depending upon the information contained in your application and any additional information required to complete the underwriting process. Pre-existing conditions may not be covered. You should not cancel any existing medical insurance until you have received written confirmation that your application has been approved.

Fort Dearborn Life Insurance policies
Fort Dearborn Life Insurance policies are no longer being offered in conjunction with the Health Check Basic, Select, or HSA plans and are no longer included as part of the cost of the health care plans.

Agreement
I understand and agree that the rates provided are preliminary and that final rates are subject to change based on the underwriting process, should I decide to apply for coverage. I also understand that no coverage will be in effect until an application is submitted and approved by the company. I also understand that there are requirements I must meet to be eligible for this and that pre-existing conditions may not be covered.