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With the termination of Grandfathered plans and the recent Executive Order regarding Short Term Medical plans, You MAY have options. These plans do NOT cover Pre-existing conditions, are medically underwritten and you may be denied coverage. Copays for doctors and prescriptions are generally NOT covered. HOWEVER–if you qualify–these plans MAY be an effective alternative to ACA Plans. Please complete the confidential fact-finder to get started.
Short Term Fact Finder Application
*
Indicates required field
FIRST NAME
*
Spouse First
*
Child1 First
*
Child 2 First
*
LAST NAME
*
Spouse Last
*
Child1 Last
*
Child 2 Last
*
Gender
*
Male
Female
Male to Femalel
Female to Male
Sp. Gender
*
Male
Female
M/F
F/M
C1 Gender
*
Male
Female
M/F
F/M
C2 Gender
*
Male
Female
Male to Female
Female to Male
Birthday M/D/Y
*
Sp. Birthday
*
C1 Birthdate
*
C2 Birthday
*
Height
*
Sp. Height
*
C1 Height
*
C2 Height
*
Weight
*
Sp. Weight
*
C1 Weight
*
C2 Weight
*
If born within 30 days prior to the effective date of coverage, the person will not be covered under the policy.
Applicants must meet our height and weight guidelines to qualify for coverage.
Address
*
Email
*
City
*
State
*
Zip
*
Phone Number
*
County
*
Application Questions
Has Anyone Had...Medical History Information
Are you or is any family member (whether or not named in this application) an expectant mother or father, in the process of adopting a child, or undergoing infertility treatment?
If yes, coverage cannot be issued.
Within the
last 5 years
has any applicant received medical or surgical consultation, advice, or treatment, including medication for
any of the following:
blood disorders, liver disorders, kidney disorders, chronic obstructive pulmonary disorder (COPD) or emphysema, diabetes, cancer, multiple sclerosis, heart or circulatory system disorders (excluding high blood pressure), Crohn's disease or ulcerative colitis or alcohol or drug abuse or immune system disorders?
If yes, select each person
*
Primary
Spouse
Child 1
Child 2
_____
*
Yes
No
_____
*
Yes
No
Has any applicant had testing performed and has not received results, or been advised by a medical professional to have treatment, testing, or surgery that has not been performed?
(The person(s) named will not be covered under the policy).
If yes, select each person
*
Primary
Spouse
Child 1
Child 2
_____
*
Yes
No
Within the
last 5 years
, has any applicant received treatment, advice, medication, or surgical consultation for Human Immunodeficiency Virus infection from a doctor or other licensed clinical professional, or had a positive test for Human Immunodeficiency Virus infection performed by a doctor or other licensed clinical professional?
If yes, select each person
*
Primary
Spouse
Child 1
Child 2
_____
*
Yes
No
Submit
Insurance
Home & Auto Insurance
>
Travelers - Customer Services
Hartford - Customer Services
Nationwide Customer Service
National General Customer Service
Health Insurance
>
ACA 2025 Checklist
Medicare
Accident & Hospital
>
Accident Plans
Critical Illness
Long-Term Care
Disability Insurance
Pet Insurance
Life Insurance
Travel Medical and Trip Protection
Dental and Vision
Employee Benefits
Business Owners
>
Group Health Insurance
Commercial Property & Liability
Business Overhead Expense Disability
Disability for Business Owners
Critical Illness
Short Term Health
Trout Team
Our Story
Dave Trout
David Hanson
Idelle Davids
Jan Trout
Steve Dillingham
Resources
Employee Success
Join The Team
Fixing the ACA "Family Glitch"
Aetna/CVS Health NC
Medicaid Expansion
Client Center
Newsletter
Reviews
Blog
Articles
>
Privacy Policy
Health Insurance 2022
Friday Health
Comparing 2022 Plans
Insurance Partners
Best Value Insurance Plans
ARP Facts CMS
ARP Unemployment
No Income Cap
Unemployment Glitch
Asheville Homesharing
2019 Verification-a
BCBS Online Setup
APTC Income 2023 & Tax Form 1040
Prior Agents
Lost Subsidy
Community
Built to Last
Candlelight Stroll
50+ WNC Articles
Understanding Medicare 2024
Weaverville Primary Spring Fling
Alignment's 5-Star Switch
Employer Networking w/ Just Economics
FALLing with Families
Blue Ridge Pride Festival
Goombay & YMI
YMI Winter Coat Drive
Medicare Seminar
Art in Autumn + MANNA
Music on Main
Western Women's Business Center Conference
Mural on Main Street
Back to School
Weaverology
Contact Us