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Formulario de cotización
Género
- Male
- Female
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- List is empty.
Estado civil
- Soltero (a)
- Casado (a)
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Tipo de cotización que desea
- Mercado de seguros médicos (Obamacare)
- Plan de descuento
- Multiplan privado
- Plan contra accidentes
- Plan de indemnización Hospitalaria
- Seguro de vida
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¿El conyuge aplicará al seguro?
- Yes
- No
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Género del conyuge
- Male
- Female
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Tiene dependientes en sus taxes
- Yes
- No
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Declarará impuestos como casado
- Yes
- No
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Cuantos dependientes declarará en sus taxes
- 1
- 2
- 3
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Género del dependiente 1
- Male
- Female
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¿El dependiente 1 necesita seguro?
- Yes
- No
- Have Medicaid
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Genero del dependiente 2
- Masculino
- Femenino
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¿El dependiente 2 necesita al seguro?
- Si
- No
- Tiene Medicaid
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¿El dependiente 3 necesita seguro?
- Si
- No
- Tiene Medicaid
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Genero del dependiente 3
- Male
- Female
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Ingreso anual familiar aproximado
- $0 - $25,000 USD
- $25,001 - $42,000 USD
- $42,001 - $55,000 USD
- + $55,000 USD
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