Quote

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Full Benefits Program* This field is required.
Full Program : Major Medical Healthcare, Living Benefits Life Insurance, Dental, Vision, Retirement planning.
Full Program : Major Medical Healthcare, Living Benefits Life Insurance, Dental, Vision, Retirement planning.
Full Comprehensive Benefits Coverage: Healthcare, Life, Dental, Vision, Retirement Planning
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Who needs to be covered?* This field is required.Which Best Describes Your Situation?
Single, No Dependents
Single with Dependents
One Married Adult, No Dependents
One Married Adult with Dependents
Married Couple, No Dependents
Married Couple with Dependents
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*CREDITS and FUNDING please check all that apply:Select all that apply. Documentation may be required.
New Job last 90 days
Work at Small Business - less than 20 staff
Work at Small Business - less than 50 staff
In a Temp Pool or company
Do not owe back taxes
Educator - non management
Transportation - government staff
Minority
First Responder
Gold Star Family
Farming industry
Caring for extended family (documented)
Adult/Professional Continuing education within 2 years (16+ weeks)
Contractor / Self-employed / Business owner
Fitness or athletic membership
Currently attempting tobacco cessation
An insured in school and or college/university
Retirement, savings and IRA contribution
No ER claims in 12 months
Cancer diagnosis (ongoing, remission)
Loss of family member in household within 2 years
Veteran
New Baby
Same Address over 5 years (within the last 3 years)
Hybrid or EV Car owner
Recent or current COBRA offer/coverage
Hospitality/Cosmetology/Uber/Lyft/Taxi
Spouse with job less than $15,000
Receiving Disability
Caring for Disabled Dependent
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Primary Age* This field is required.Age of the Primary Insured
Please Select one:
Please Select one:
19
20
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Age of Primary Insured
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Primary Date Of Birth* This field is required.Primary's Date of Birth
Date
Month
Day
Year
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Primary Age DUP
Please Select one:
Please Select one:
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Age of Primary Insured
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Primary-Age-calc
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Primary Gender* This field is required.
Male
Female
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Primary is a Tobacco user?* This field is required.Cigarettes, vape, Pipe, Pinch, more than once weekly
Yes
No
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Spouse Age* This field is required.Age of Spouse
Please Select one:
Please Select one:
19
20
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24
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Age of Spouse
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Spouse Date Of Birth
Date
Month
Day
Year
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Spouse GenderMale or Female Biology
Male
Female
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Is your spouse a tobacco user?Cigarettes, Vape, Pipe, Pinch, more than once a week
Yes
No
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How many dependents under 19?* This field is required.As claimed on taxes
Must Select one:
Must Select one:
0
1
2
3
4
5
6
7
Over 7
Dependent over 24
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How many dependents 19 and older?* This field is required.As claimed on taxes
Please Select one:
Please Select one:
0
1
2
3
4
5
6
7
Over 7
Dependent over 24
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NOT SP price
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Primary Age+Tobacco+Gender Calc
Number1
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Spouse Age+Tobacco+Gender Calc
19
Today
Date
Month
Day
Year
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Legacy dependents under 19
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Legacy dependents 19 and over
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Days
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spouse age
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Residence State* This field is required.
Please Select one:
Please Select one:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
PR
State of Residency
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County* This field is required.
What county do you live in?
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Zip Code Search* This field is required.
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Select Income Range *use your AGI not gross* This field is required.
Please Select one:
Please Select one:
12,500 - 17,000
17,001 - 25,000
25,001 - 30,000
30,001 - 35,500
35,501 - 40,000
40,001 - 45,000
45,001 - 50,000
50,001 - 55,000
55,001 - 60,000
60,001 - 65,000
65,001 - 70,000
70,001 - 80,000
80,001 - 90,000
90,001 - 100,000
100,000 - 220,000
220K +
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When do you need the coverage to start?* This field is required.
Date
Month
Day
Year
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Start Date Can not be Today. Please Select a Start Date in the Future.
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User Agent String
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FLOOR
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Email
example@example.com
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* This field is required.
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YOUR SURE PLANS MONTHLY PRICE OFFER:THIS IS YOUR TOTAL PREMIUM FOR THE YEAR! LOCK IN SAVINGS Click NEXT -->
***Offer Good with Verified Information You Entered *** TAKE OFFER NOW BY VERIFYING YOUR EMAIL --> Next Step
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Without Sure Plans Programs funding and credits the offered Program with Qualified Healthcare, Life, Dental and Vision Insurance and benefits could cost as much as  ${notSp}.

Based on your provided information for your Sure Plans Program you qualify for a monthly total offer of  ${yourSure}.

If the monthly rate is acceptable we can email you the details.

To see the benefits details there is no obligation, click next to save your price and review your Program details in writing.

Programs are custom to you not for any other situation or person. Please note your provided information must verify as accurate. Any changes in provided information may change or nullify your Offer. Complete Program Information including benefits coverage details and documents will be emailed to you for review before any commitment. Enrollment specialists will review and can further customize offers. PLEASE NOTE: You must 1. Answer our call and speak to an Enrollment Specialist within 3 days of recieving your emailed Program Information and 2. Enroll within 7 days of emailed Program Information for the price offered.

Verify your email in the next step to get this price.
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*OFFER Conditional Upon The Following:

Timely Verification of Information You Entered. Please Note: we may require supporting documentation. We may reach out via text, phone and or email for documentation.

You are the Decision-Maker/Payer.

You Agree to Provide Required Documents.

Continuous Monthly Auto Drafts.

Your Accurate eMail and Contact Phone Number Entries.

You Must Accept to Enroll within 10 days.

Rate No-Increase Guarantee Conditional Upon 15 Successive Successful Payments of Agreed Total and Quarterly Replies to Administration Email Membership Updates.

You and any Dependents are Legally Allowed to Enroll in MajorMedical, Life, Dental, Vision and Retirement Plans in Active United States Before today.
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Payer Full Name to Accept Offer* This field is required.Please Enter Payer's Name to Accept the Rate Offered.
first
last
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Phone Number to Lock Price:* This field is required.Daytime Phone.
phone required
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Email required* This field is required.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code?or
Receiving the email may take a few minutes, thank you for your patience!
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