Health Indemnity Plan

• Accidental Insurance
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Indemnity Plans Offer You Maximum Flexibility

Affordable Health Insurance Inc. is the leading insurance broker for Indemnity Health Plans in Arlington Heights and Chicago, Illinois. We’re also a top broker for the Midwest including Indiana, Wisconsin, and Ohio. Living somewhere else in the U.S. such as Texas or Arizona? We can help you too, contact us today and we can point you in the right direction.

Indemnity health insurance is an insurance option that allows for the greatest patient control over his or her personal care, but is also an option whose cost can run higher than the traditional HMO and PPO. Indemnity health plans are referred to Fee-for-service health plans because there is no limit to a network of doctors and the patient pays the costs upfront, submitting the claim to be reimbursed.

There are three major types of indemnity health insurance: basic, major medical, and comprehensive. The Basic coverage is actually quite comprehensive, covering room and board, basic care, X-rays, prescriptions in the hospital, surgery (in and out-patient) and many doctor visits. Major Medical is far limited in its scope, covering long-term care for illness or injury and both in and out-patient expenses. Comprehensive combines the basic and major medical coverage.

Affordable Health Insurance Inc. is able to provide the best indemnity health plans to individuals because we go through multiple providers. Instead of relying upon one insurance company, our agents are able to find the best possible plans and rates to match your needs. This insures that you do not overpay and are not under-covered when you purchase this primary insurance plan. Please, fill out the form below and we will get back to you with a quote.

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Marital Status:	Married Single
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Applicant’s Information: *Insured Name: *Insured DOB: *Insured Height: 4 5 6 7 0 1 2 3 4 5 6 7 8 9 10 11 *Insured Weight: Include Spouse? Spouse’s Name: Spouse’s DOB: Spouse’s Height: 4 5 6 7 0 1 2 3 4 5 6 7 8 9 10 11 Spouse’s Weight: Include Children? Name Gender Date of Birth Height Smoker Student 1. Male Female FT 1 2 3 4 5 6 7 IN 0 1 2 3 4 5 6 7 8 9 10 11 No Yes Yes No 2. Male Female FT 1 2 3 4 5 6 7 IN 0 1 2 3 4 5 6 7 8 9 10 11 No Yes Yes No 3. Male Female FT 1 2 3 4 5 6 7 IN 0 1 2 3 4 5 6 7 8 9 10 11 No Yes Yes No 4. Male Female FT 1 2 3 4 5 6 7 IN 0 1 2 3 4 5 6 7 8 9 10 11 No Yes Yes No 5. Male Female FT 1 2 3 4 5 6 7 IN 0 1 2 3 4 5 6 7 8 9 10 11 No Yes Yes No 6. Male Female FT 1 2 3 4 5 6 7 IN 0 1 2 3 4 5 6 7 8 9 10 11 No Yes Yes No Health and History Information: Does any family member living in the household use or has used any tobacco products? (if yes give dates, and details in remarks section) No Yes If yes please describe use: (cigar, cigarettes, etc, how long) Do any of the applicants have a pre-existing condition?: (if yes please describe the condition in detail and who has it) Are any of the applicants taking medication of any kind?: (if yes please give details about who takes it, for how long, etc)
Coverage Information:
Are you looking for coverage for more than 6 months?
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What deductible are you interested in?
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Please list any special coverages you might need:(Maternity, H.M.O., P.P.O., etc.)
Would you like us to include information about the new HSA (Health Savings Plans)?
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