Supplemental Insurance Calculator

Enter your information and choose which supplemental plan(s) you prefer (i.e. Hospital Indemnity, Accident, Critical Illness, Cancer, and Gap Insurance). If you have requested an Affordable Care Act quote and are also interested in a supplemental health insurance quote, please submit a supplemental insurance quote here.

Do not use this form to request supplemental quotes if you are a Medicare beneficiary. This is not a lead generating system. For the same reason quotes are not available from the system for Medicare Supplement, Medicare Advantage, and Part D Prescription Drug plans. Call us at 877-734-3884 (TTY 711) if you’re a Medicare beneficiary and want more information.

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First Name
Last Name
Email
Phone
State	Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Oregon Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Gender	Male   Female
Date of Birth
Height	- 3 4 5 6 ft   - 0 1 2 3 4 5 6 7 8 9 10 11 inch
Weight
What Type Of Supplemental Health Plan Do You Want?	Please Select Hospital Indemnity Accident Critical Illness Cancer Gap Plan
Calculating: Complete Next Step

Do you have a spouse?	Yes   No
Spouse Name
Gender	Male   Female
Smoker?	Yes   No
Date of Birth
Do you have children?	Yes   No
Child 1
Full Name
Gender	Male   Female
Smoker?	Yes   No
Date of Birth
Child 2
Full Name
Gender	Male   Female
Smoker?	Yes   No
Date of Birth
Child 3
Full Name
Gender	Male   Female
Smoker?	Yes   No
Date of Birth
Child 4
Full Name
Gender	Male   Female
Smoker?	Yes   No
Date of Birth
Child 5
Full Name
Gender	Male   Female
Smoker?	Yes   No
Date of Birth
Calculating: Complete Next Step

Tobacco Use	Please Select Yes No Quit within 6 months Quit within 1 year Quit between 1-2 years Quit over 2 years Occasional Cigar Smoker Uses Smokeless Tobacco
Disabled	Please Select Yes No
Diabetes	Please Select Yes No
Diabetes Type	Please Select Type 1 Type 2 Not Sure
Diabetes Control	Please Select Diet/Excercise Pill Controlled Insulin Controlled Pill and Insulin Controlled
Latest A1C Rating	Please Select 0-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 Over 10 Not Sure
Calculating: Complete Next Step

Do You Take Any Medications? Please Select Yes No

Below, please list medical conditions one per line, and their corresponding medications and dosages. Conditions Medications/ Dosage or Units/ Frequency.

Please provide details about conditions you are currently being treated for as well as those you've been treated for in the last three years. Include hospitalizations, surgeries and include relevant details. Be as specific as possible.

If you previously have had cancer (except for basal cell carcinoma), a heart attack, or stroke, please provide complete details, including date of diagnosis and details of treatments and current health status.

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Calculating: Complete Next Step

INFORMATION COMPLETE!

Our quoting system is now calculating the lowest rates from several carriers based on the information you provided.

You should receive your rates within one business day.

Get Insurance Anywhere is pleased to be your one-stop solution for all types of health and life insurance.

The information collected will be used by agents of Get Insurance Anywhere ONLY for purposes of helping you obtain quotes for supplemental health insurance or contacting you to provide quotes. Quotes for Medicare beneficiaries and not available on this system, We don't sell or rent your information, EVER. You're dealing directly with an insurance agent who will personally contact you and NOT with a lead generating system. See this privacy notice for more information, including how we protect your Personally Identifiable Information (PII) and Protected Health Information (PHI).