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About us
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Partners
FAQ
Contact us
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Search for:
Individual Health Insurance
Step
1
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Primary Applicant's Name
*
First
Last
Address
*
Street Address
Address Line 2
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Armed Forces Americas
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State
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Phone
*
Fax
Email
*
Applicant Information
Gender
*
Male
Female
Date of Birth
*
Month
Day
Year
Height (ft/in)
*
Weight (lbs)
*
Are you a smoker?
*
Yes
No
Are you married?
*
Yes
No
Do you want to add your spouse to the insurance policy?
Yes
No
Spouse Information
Name
First
Last
Gender
Male
Female
Date of Birth
Month
Day
Year
Height (ft/in)
Weight (lbs)
Is your spouse a smoker?
Yes
No
If you have children, do you want to add them to the insurance policy?
Yes
No
Children Information
Number of Children
Children
First Name
Gender (M/F)
Date of Birth (mm/dd/yyyy)
Height (ft/in)
Weight (lbs)
If you want to add more children, click the plus symbol.
