Kentucky Health Insurance Quote from Thoroughbred Associates

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Thoroughbred
Associates

E-mail: awinkie@thoroughbred
associates.com

Phone: 1-502-245-7841
Fax: 1-502-245-3811
Toll Free: 1-800-219-8211

On-Line Health Insurance Quotation Form One Simple Form - takes only 2-3 Minutes! NEW! Instant Online Rates One of our preferred carriers, Golden Rule Insurance Company now provides online rating AND instant policy issuance online! You may obtain your quote by Proceeding to their Online Rating Service now. You may also want to get a quote from Anthem Insurance Company online. Competitive rates, many doctor choices and plans make this a local Kentucky favorite health plan. Or, to have a representative to contact you for other options and rate multiple carriers for the most comprehensive rate options, please proceed to complete the request below. Assurant health Insurance programs are among the most competitive in the state of Kentucky. Choose from various programs and get a quote or place your coverage online now: Assurant Individual Health Assurant Short Term Health *Your Personal Data*
Your Name:
Street Address:
City:
State:	MUST be Kentucky!
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):

Marital Status: Single Married	Do You Own Your Own Business? Yes No

Health Ins. Currently? (If yes, list carrier, and # of years continuous. If none, type N/C)

UNDERWRITING INFORMATION

Insured Name:		Birthdate:
Insured Height:		Insured Weight:
Insured Occupation:		Hazardous Activities? (if yes, describe):
Sex (M/F):		List children's ages to be covered
Be as specific as you can on the underwriting questions below so we may find the most competitive product for you!
Do You use tobacco?	Yes No	Describe usage (cigar, cigarettes, etc.)

Any Pre-existing Health Conditions?		(If yes, descibe in detail, and to which of the insured persons they apply.)

Any Covered Persons Currently Taking Medication of Any Kind?		(If yes, descibe in detail, and to which of the insured persons they apply.)

*COVERAGE INFORMATION*

How Long Do You Need Coverage For? (if short term, etc.)

What Deductible Do You Want? ($250, $500, $1000, etc.):

Any special coverages needed? (Maternity, H.M.O., P.P.O., etc.)

Tell Us What You Want MOST in your Health Plan, or list any other Remarks here:

Send my quotation via: E-Mail Fax
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Thank you for filling out this form COMPLETELY!
We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me My
Health Insurance Quote NOW!

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