THE 2 MINUTE HEALTH INSURANCE FORM

We have been helping families get affordable health insurance since 2014

Three questions, and 90% of people can get affordable health insurance

CLICK BUTTON TO START

This does not stop you from qualifying for FREE Health insurance thanks to government subsidies.

Do you currently have health insurance through the marketplace? *

Yes

Don't Know

(3 Screening questions, only 2 more questions for FREE health insurance!)

Question 2

Do you have Medicare, Medicaid or VA Health Insurance? *

Yes

UNFORTUNATELY WE ARE UNABLE TO PROVIDE INSURANCE FOR ANYONE WHO ALREADY HAS COVERAGE

We're sorry that we're unable to help you at this time but if you know anyone else who needs health insurance and doesn't have existing coverage, please send them this form. Hopefully we can help them get affordable health insurance!

Last Question!

A dependent is someone who is on the same tax return as you. Could be children, parents, siblings etc

What is your tax household? *

Single with no dependents

Single with dependents

Married with no dependents

Married with dependents

YOU'VE SUCCESSFULLY PASSED THE PREQUALIFICATION QUESTIONS

You are one step away from new affordable coverage.

We work with every carrier in the state and will always choose plans with the best coverage available, the lowest deductibles, copays, and premiums!

Our goal is to get you a $0 PREMIUM plan!

Your Gender *

Male

Female

First Name *

Last Name *

Cell Phone Number (so we can text you your confirmation) *

Your Date of Birth (to confirm you qualify) (mm/dd/yyyy) *

State *

Click if the above information is correct

Last few questions

Do you personally need insurance? *

Yes

Plan Choice *

Get me the plan with the best benefits and the best insurance company

I want to keep my current insurance company. Just upgrade my plan

Everyone applying for insurance is required to provide their social security number directly to the government and insurance company to verify your identity within 90 days of your application. If not provided, your insurance will be terminated.

We will send you reminders via email, text and phone calls before it's terminated.

Security Questions

Because robots can't get insurance!

If you could go anywhere in the world you would go to______?

Destination *

How much are you currently paying for Health Insurance? *

What is your monthly budget for Health Insurance? *

Required Legal Compliance

Sign Below

Clear

CLICK RED BOX BELOW

I hereby consent to the below terms and conditions:

Terms and Conditions

This is a request for The Insurance Market Group and Howard Rabinowitz to perform the following on behalf of myself and members of my household: 1) Contact me via text message regarding all aspects of my health insurance 2) Search for, access, view and use the information in my Federally Facilitated Marketplace (FFM) Account to assess my current coverage in order to update, complete and submit an application for the best Qualified Health Plan available in my area. 3) Provide ongoing account maintenance and assistance as necessary, 4) Respond to inquiries from the Marketplace on my behalf, 5) assist in the enrollment of any rewards programs offered by my Insurance company. 6) Create a FFM Account on my behalf for the aforementioned purposes if one does not already exist. 7) In order to perform all requests I give permission to Howard Rabinowitz to serve as mine and my households current health insurance agent of record 8) I understand that my information will be kept safe and not shared for any purpose besides listed previously. 9) I confirm that all eligibility information that I have provided has been reviewed by myself to be both accurate and true to the best of my knowledge. 6) My consent remains in effect for 36 months and I may modify or revoke it at any time by providing my agent written notice by text to the following number 561-330-5512

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market group

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$0 PREMIUM

$0 DEDUCTIBLE

$0 Generic Drugs

$0 Doctor Visits

$0 PREMIUM

$0 DEDUCTIBLE

$0 Generic Drugs

$0 Doctor Visits

Old Way

Spend all your time on the phone to an Agent

Find a licensed health insurance agent

Call them, leave a message, call again

Spend hours answering their questions

Wait to hear if you're approved then pay

New Way

Very Easy Online Application

NO PHONE CALLS FROM AGENTS!

Agents will only text you

The entire enrollment is done for you

If you don't like the plan, you just dont pay!

Old Way

Spend all your time on the phone to Insurance Agents

Find a licensed health insurance agent

Call them, call them again, leave a message, call them again

Spend hours on the phone answering their questions

Pay for your health insurance and never hear from them again

New Way

Very Easy Online Application

NO PHONE CALLS FROM AGENTS! We will Never Call You

Agents will only text you

The entire enrollment is done for you.

If you don't like the plan, you just don't pay for it!

How it works

Step 1

Complete a short online form

Step 2

Our experts will determine if you qualify.

90% of our clients can be enrolled

without ever speaking to an agent!

Step 3

An agent will send you a text message with your new insurance information.

everything is done for you!

APPLY NOW

How it works

Step 1

Complete a short online form

Step 2

Our experts will determine if you qualify.

90% of our clients can be enrolled

without ever speaking to an agent!

Step 3

An agent will send you a text message with your new insurance information.

Everything is done for you!

Apply Now

All thanks to

Government Subsidies!

The Inflation Reduction Act lowers Health Care costs for Millions of Americans!

Now 4 out of 5 people can find health coverage!

All thanks to

Government Subsidies!

The Inflation Reduction Act lowers Health Care costs for Millions of Americans.

What clients say about us

This was so easy! What a pleasure not having to answer tons of phone calls from insurance agents! I signed up online and everything was done for me. I'll always be getting my health insurance this way from now on. And the best part is my premiums are now less than $10 a month!

What clients say about us

This was so easy! What a pleasure not having to answer tons of phone calls from insurance agents. I signed up online and everything was done for me. I'll always be getting my health insurance this way from now on. And the best part is my premiums are now less than $10 a month!

© 2021 theinsurancemarketgroup. all rights reserved

© 2021 theinsurancemarketgroup. all rights reserved