Get a policy quote! Start the quote process by filling out the information below. Is an applicant age 75 or older? Please contact us directly for a specialized quote. Step 1: What annual deductible would you like to quote? $500 $1000 $2500 $5000 How do you want to pay your premium? (The total premium amount will be multiplied by the corresponding factor listed next to the options). Monthly (x.10) Quarterly (x.28) Semi-Annual (x.55) Yearly (x1.0) Step 2: Please enter the people that will be insured on this policy. One policy per family. (Leave boxes blank if they do not apply.) Name (Last, First) Age Range Sex If 19-23, full-time student? Primary 14 days through 18 years 19 through 29 years 30 through 39 years 40 through 44 years 45 through 49 years 50 through 54 years 55 through 59 years 60 through 64 years 65 through 69 years 70 years 71 years 72 years 73 years 74 years Male Female   Spouse 14 days through 18 years 19 through 29 years 30 through 39 years 40 through 44 years 45 through 49 years 50 through 54 years 55 through 59 years 60 through 64 years 65 through 69 years 70 years 71 years 72 years 73 years 74 years Male Female   Child* 14 days through 9 years   10 through 19 years 20 through 24 years Male Female Yes No Child* 14 days through 9 years   10 through 19 years 20 through 24 years Male Female Yes No Child* 14 days through 9 years   10 through 19 years 20 through 24 years Male Female Yes No *The Dependent Child premium is charged when at least one parent (legal guardian), of a natural or legally adopted unmarried child over 14 days old and under 19 years of age (or under 24 years of age if attending a university full-time and must rely on parents for support), is also covered under the same program. No premium is charged for the first two (2) Dependent Children between the ages of 14 days and 9 years old if both parents are also covered under the same program. Step 3: Press the "Get Quote" button to see your premium information. You can then return to this page to re-quote, continue to apply online, or apply later. Press "Reset Form" if you wish to clear out form and re-enter new information.

| ELIGIBILITY | SCHEDULE OF BENEFITS | RENEWABILITY | EMERGENCY EVAC/REPATRIATION | EMERGENCY REUNION BENEFITS | UTILIZATION MGMT PROGRAM | UNDERWRITING | EXCLUSIONS

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