lkj
Find plans designed for individuals inpatient and outpatient hospital and physician expenses, preventative care, prescription drugs and more. LKJ Financial will help you select the individual insurance plan that best fits your needs.

Questions to consider:

  • Are you looking for very comprehensive coverage, like what you might get from an employer's plan?
  • Are you looking for something low-cost to protect yourself/your family against a medical catastrophe?
  • Are you interested in using tax-free dollars to pay for your medical costs?
  • Are you in transition and only needing coverage for a short amount of time?

Individual Medical Quote

Name:

Email:

Phone:

Street:

City:

State:

Zip:



What kind of policy are you interested in?

Interested in a policy for less than 1 yearInterested in a policy for longer than one yearInterested in life insuranceInterested in dental/vision insurance


Primary:

Date of Birth Sex Height? Weight Tobacco Use?
, MF lbs. YN

Dependent Adult (i.e. spouse) to be covered on your plan:

Date of Birth Sex Height? Weight Tobacco Use?
, MF lbs. YN

Dependent child(ren) to be covered on your plan:

Child 1
Age: yrs.  Sex: MF Tobacco use? YN

Child 2
Age: yrs. Sex: MF Tobacco use? YN

Child 3
Age: yrs. Sex: MF Tobacco use? YN

Child 4
Age: yrs. Sex: MF Tobacco use? YN

Child 5
Age: yrs. Sex: MF Tobacco use? YN

Has anyone ever been treated for any of these conditions? (Check all that apply)

Heart DiseaseCancerAllergiesAsthmaDepressionThyroidHigh Blood PressureHigh CholesterolSleep Apnea

Medications taken currently: (Indicate individual who takes medications, medication name, dosage and frequency)

Is anyone in the household now pregnant or an expectant parent?
YesNo


Prefer the phone? Call us at 713.840.0534