Tell us about your family
Effective date
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Within 30 Days
Within 30-90 Days
Within 90-120 Days
Over 120 Days
Number of dependents on your plan
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0
1
2
3
4
5
6
7
8
9
10
11
12
Age of oldest person on your plan
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0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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46
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48
49
50
51
52
53
54
55
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58
59
60
61
62
63
64
Number of smokers on your plan
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0
1
Current State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
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Maryland
Massachussetts
Michigan
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New York
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Current monthly premium
$