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Get your No Obligation Individual Health Quote Here!!! All we need is the following information. We will complete your comprehensive health proposals immediately. If you prefer - contact us toll-free direct @ 1-888-569-0401. First Name: Last Name: Individual Health Plans Email: Phone: County: State: IllinoisMissouri Zip Code:   Gender Age Health Class Applicant MaleFemale 181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465 Preferred Standard Tobacco Spouse N/AMaleFemale 181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465 Preferred Standard Tobacco Child 1 N/AMaleFemale 0123456789101112131415161718192021 Standard Child 2 N/AMaleFemale 0123456789101112131415161718192021 Standard Child 3 N/AMaleFemale 0123456789101112131415161718192021 Standard Child 4 N/AMaleFemale 0123456789101112131415161718192021 Standard Child 5 N/AMaleFemale 0123456789101112131415161718192021 Standard Child 6 N/AMaleFemale 0123456789101112131415161718192021 Standard *Select all family members that will be covered by this policy Select the preferred health rating class if you have no pre-existing medical conditions, take no maintenance medications, and have a good height to weight ratio. Select the standard health rating class if you take any maintenance medications, you are somewhat overweight, or have any pre-existing medical conditions. Select the tobacco rating class if you have used any form of tobacco in the last 12 months. Children are always assigned the standard health rating class. Medical Questions:   1. Are any applicants currently pregnant?   Yes  No  2. Has anyone been confined to a hospital in the past 24 months?   Yes  No  3. Has anyone received treatment for cancer, stroke, diabetes, psychological / alcohol / drug treatments and / or disorder of the heart/kidney/immune system?   Yes  No  Please add any comments you have below: Click for MissouriHealthQuote.com Privacy Policy Copyright 2002-2003 St. Louis Benefits Group. All rights reserved.