Barthel & Associates Insurance

Get A Quote For Short Term Health Insurance

Temporary Health Insurance is for people who are:

• Between jobs
• Looking for a lower-cost alternative to COBRA
• Recent college graduates
• Waiting for employer sponsored coverage

Who is eligible?

Healthy individuals between the ages of 30 days and 64 years 11 months, who have temporary insurance needs.

Dependent children through age 18 (24 if full-time student) may be covered as dependents on their parent's plan.

Fill out the form below for us to create a free custom quote or see the below link to securely quote yourself.

[you will be taken to our secure quote area on the Assurant Health® website]

-or-

[you will be taken to our secure quote area on the Golden Rule® website]

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Custom Quote Form

Desired Effective Date:

Name:

Company:

Address:

City:

State:

Zip:

If you would like Short term Medical Insurance information with an application sent to you, submit this form without completeing the bottom portion.

E-Mail:(required)

Phone:

I prefer a phone response:

I prefer an e-mail response:

Message/Comments:

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List those you wish to have covered

	Gender	Date of Birth	Smoker
Applicant	Male  Female		Yes  No
Spouse	Male  Female		Yes  No
Child 1	Male  Female		Yes  No
Child 2	Male  Female		Yes  No
Child 3	Male  Female		Yes  No
Child 4	Male  Female		Yes  No
Please Select a plan design best for you:	Length of coverage 30 to 185 days:	Deductible options: $250$500$1000$2500	Rate of payment: 50%80%100%

Comments: If you have any coverage preferences..such as Prescription Drugs, Maternity, Deductibles etc.:

Security Code:(required)