Low cost personal and business insurance from First Insurance Group, Somerset, KY
personal insurance quotes for Somerset, KY residents
Kentucky personal insurance get a commercial insurance quote from First Insurance Group
discount Kentucky business insurance get in touch with First Insurance Group, Somerset, KY
save on your insurance from First Insurance Group more about first insurance group

On-Line Personal Health
Insurance Quotation Form

One Simple Form - takes only 2-3 Minutes!


Your Personal Data

Your Name:
Street Address:
City:
State: (Must be Kentucky)
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone (if more info. needed):
Fax (optional):
Primary Insured's Occupation:
 
Marital Status:
Single Married
Gender:
Male Female
 
Type of Health Insurance
you have currently?


UNDERWRITING INFORMATION
 
Insured Name: Birthdate:
Insured Height: Insured Weight:
Spouse's Name: Spouse's Birthdate:
Spouse's Height: Spouse's Weight: (M/F):
 
Include Spouse?: Yes No Include    
Children?:
Yes No
 
List children's names,
(first & last), their
relationship to you,
and birthdates:
(up to 6 children)
Name/Rel.:B-Date: M/F:
Name/Rel.:B-Date: M/F:
Name/Rel.:B-Date: M/F:
Name/Rel.:B-Date: M/F:
Name/Rel.:B-Date: M/F:
Name/Rel.:B-Date: M/F:
 
Be as specific as you can on the underwriting questions below so we may find the most competitive product for you!

Does any family member living in the household use or has used any tobacco products? (if yes give dates, and details in remarks section).
Yes   No

Describe usage (cigar,
cigarettes, etc, and how long.)
      

 
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
 
Are You Looking for Coverage for more than 6 months?
 
What Deductible Are You Interested In?
($250, $500, $1000, $2000 etc.):
 
Any special coverages needed?
(Maternity, H.M.O., P.P.O., etc.)
 
If you're looking to reduce premium cost, and want information on the NEW HSA (Health Savings Plans), check the HSA box here and we'll include information. Please Include HSA Information
 
Tell Us What You Want MOST in your Health Plan, or list any other Remarks here:


Send my quotation via: E-Mail Fax
Regular Mail
Call me by Phone!

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!


Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!

   

"First Insurance Group Delivers Advantages That Become Your Competitive Edge."

we help Kentucky business find the perfect workers comp insurance First Insurance Group Offers Insurance Products and Services that:

  • Provide the highest levels of insurance protection for you and your family at the most affordable price.
  • Save you time and money.
  • Give a positive impact on your life as an employer and the lives of your employees and their families.
  • Provide time-saving tools and applications that create real value.
  • Offer benefit programs that allow you to attract, recruit, and retain top talent.
  • Give you and your family peace of mind and a road map to follow for years to come.


    Our Featured  Insurance Programs - The Best Coverages & Prices:

    low Kentucky auto insurance rates
    Auto Insurance
    first insurance group
  • LOW Good Driver Rates.
  • Huge Auto-Homeowners Multi-Policy Discounts!
  • Same-Day Coverage.
  • We Shop Multiple Companies for Best Value. get a fast, free KY insurance quote today!

    we help Kentucky business find the perfect workers comp insurance
    Workers Comp

  • We Correct Rating Errors!
  • Great Rates With Leading Insurance Companies.
  • New Ventures OK!
  • Companies With Prior Compensation Claims OK. get a fast free workers compensation insurance quote today!

    first insurance group represents Kentucky's finest insurance companies
  • Copyright 2012 | First Insurance Group, Somerset, KY | Terms of Use / Privacy Notice / Copyright Info