• NPN# 19088764

  • Watson Health Group Benefits Request Form

  • Household Information

  • Date of birth*
     - -
  • Is there anyone else applying for coverage?*
  • When it comes to your health coverage, how are you feeling right now?There's no wrong answer — just want to make sure I understand where you're coming from.*
  • What feels like the biggest challenge with your coverage right now?*
  • How often do you feel stressed about your health insurance situation?*
  • Which part feels hardest to deal with right now?*
  • How would you describe your current coverage situation?*
  • What has held you back so far?*
  • What matters most to you in a plan?*
  • Which trade-off would you be most comfortable making?*
  • How important is keeping your current doctors and prescriptions?*
  • How soon are you hoping to get something in place?*
  • About how does your household income compare to what you think qualifies for help?*
  • Do you currently have government coverage?*
  • Have any of these happened recently?*
  • Should be Empty: