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Consent Acknowledgement:*
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Yes, I give permission to Best Policy, LLC, My Health Insurance, LLC, and Insurely, LLC and their affiliates to access and to renew my 2025 insurance policy on the Federally Facilitated Marketplace (FFM), Short-term medical plans or the best option that suits needs outside of the marketplace, based on the information provided. I also give them consent to contact me through: email, SMS, phone, automated dialing systems, and AI-generated or pre-recorded calls. Consent is not required to purchase.*
Yes, I give permission.
Su nombre
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First Name
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Correo electrónico
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Why do you need my personal information? (email, phone number, address, etc)
Your personal information is used only to find you the best health insurance plan and contact you. We value your privacy, store your information securely, and won't use it for other purposes or send you spam.
Teléfono
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Solicitante principal Fecha de nacimiento
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Dirección
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Please select the value closest to your estimated 2024 Anual income
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Please select the value closest to your estimated 2024 income
Debes tener al menos 19 años para Continuar
Have you had any surgeries?
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No
Sí
Surgeries
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Are you currently taking any prescription medications?
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No
Sí
Prescription medications
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Have you ever been diagnosed with, received advice for, or been treated for any of the conditions listed below?
Ninguno
Major conditions
Autoimmune and Immune-Related Disorders
Neurological and Mental Health
Other High-Risk Conditions
Select all that appy.
Select all Major Condition that apply:
Cancer (current or history of cancer in recent years)
Heart disease (coronary artery disease, heart attack, heart surgery, stents, congestive heart failure, etc.)
Stroke or TIA (transient ischemic attack)
Chronic obstructive pulmonary disease (COPD), emphysema, or severe asthma
Diabetes (especially insulin-dependent)
Chronic kidney disease or kidney failure
Liver disease (hepatitis, cirrhosis)
Select all Autoimmune Condition that apply:
HIV/AIDS
Lupus
Multiple sclerosis
Rheumatoid arthritis (moderate to severe)
Other serious autoimmune conditions
Select all Neurological and Mental Health Condition that apply:
Epilepsy or seizure disorders (uncontrolled)
Alzheimer’s, Parkinson’s, or other degenerative neurological conditions
Schizophrenia or severe mental illness requiring hospitalization
Select all Other High-Risk Condition that apply:
Organ transplant history
Hemophilia or serious blood disorders
Currently pregnant or planning pregnancy
Hospitalization, surgery, or diagnostic testing recommended but not yet completed
BMI at extreme high or low ranges (varies by insurer)
Al proporcionar su número de teléfono y enviar este formulario, da su consentimiento para recibir mensajes de texto automatizados y de agente sobre actualizaciones del seguro ACA (Ley de Asistencia Asequible), información de inscripción y ofertas relacionadas.
Sí, doy permiso.
Message Frequency: You may receive recurring messages based on your interactions and ACA enrollment cycle.
Tarifas de mensajes y datos: Pueden aplicarse tarifas estándar de mensajes y datos. Consulta los detalles con tu operador de telefonía móvil.
Exclusión voluntaria: Puede darse de baja en cualquier momento respondiendo STOP a cualquier mensaje de texto. De este modo se le dará de baja de futuras comunicaciones.
AYUDA: Para obtener ayuda, responda AYUDA a cualquier mensaje o póngase en contacto con nuestro equipo de asistencia en info@bestpolicy.co.
Su consentimiento para recibir mensajes de texto no es una condición para adquirir bienes o servicios.
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