New York Health Insurance Quotes

We are your local Long Island, NY insurance agency, offering affordable
New York family or individual Health Insurance policy quotes in the
following New York City area cities and counties: Oyster Bay,
Huntington, Glen Cove, Port Washington, Roslyn, Syosset, Jericho, East
Hills, Great Neck, South Huntington, Melville, Pinelawn, Farmingdale,
Bethpage, Levittown, Lindenhurst, Babylon, Bay Shore, Islip, Northport,
Hicksville, Westbury, Mineola, Garden City, Long Island City, Manhasset,
Massapequa, Freeport, Lynbrook, Rockville Centre, Hempstead, Elmont,
Valley Stream, Long Beach, Oceanside, Amityville, Merrick, Bellmore,
Jamaica, Brooklyn, Bronx, Flatbush, Queens, Astoria, Cove Neck,
Bayville, Locust Valley, Lattingtown, Matinecock, Mill Neck, Sea Cliff,
Centre Island, Brookville, Locust Grove, Muttontown, East Norwich, Old
Westbury, North Massapequa, Seaford, Manorhaven, Huntington Station,
Huntington Bay, Greenlawn, Commack, Plainview, Deer Park,
Farmingdale, West Babylon, Brentwood, Central Islip, East Northport,
Centereach, Coram, Riverhead, Lido Beach, New Suffolk, Port Jefferson,
and everywhere else in Nassau County, Queens County, Kings County,
New York County, Bronx County, Westchester County, and Suffolk
County, NY.

**Information received from this Health Insurance quote request form sent
to Insurance Plus will be for our use only and will not be sold, given to or
distributed to any other parties. A quote will be based on the health
insurance policy information provided and does not guarantee acceptance
of the risk by us. The precise coverage afforded is subject to meeting
underwriting guidelines, and the terms, conditions and exclusions of the
policy as issued. By submitting this request you acknowledge that
this is neither an offer to insure nor a guarantee of insurance.
Completion of this form does not entitle you to a New York family or
individual Health Insurance Policy. We are licensed in New York and
will not provide health insurance quotes for other states.

Full Name:
Home Address:
City:     State:     Zip Code:
Email Address: (Required)
Home Phone: Work Phone: Ext.
How to Contact You:
Date of Birth:             (mm/dd/yyyy)
Gender:    Height: ft.
Weight:    Do you smoke?

Do you currently have health insurance?
Type of health insurance currently owned:
Current Premium:$ per month

Family Health Insurance Coverage For:
How many children to be insured?

HMO Health Insurance   HMO Co-Pay Amount Desired:
PPO Health Insurance     PPO Deductible Amount Desired:
POS Health Insurance     POS Co-Pay Amount Desired:
Major Medical Health Insurance      Deductible Amount Desired:

Choose Benefit Options:
Individual or Family Dental Insurance Coverage:
Individual or Family Vision Insurance Coverage:

Medical History
Within the last 2 years have you or any person to be insured been aware of, diagnosed
and /or been treated by a member of the medical profession for: heart disease or
disorder, stroke, cancer, diabetes, drug or alcohol dependency, mental disorder,
emphysema, airway or pulmonary disease, crohn's disease or ulcerative colitis,
nervous system disorder, liver disorder, kidney disorder, crippling or disabling
arthritis, spinal disc disease, knee or hip disorders?

If "Yes", please list information below.

Have you or any person to be insured been hospitalized
within the past 12 month, due to be so confined or been
disabled for more than 5 days within the past 12 months?

If "Yes", please list information below.

During the last 5 years have you or any person to be insured been diagnosed by a
member of the medical profession as having Acquired Immune Deficiency Syndrome
(AIDS) or AIDS related complex (ARC) or tested positive for HIV?

If "Yes", please list information below.

Additional Information or Comments

Click on the "Submit Quote Information" button below to
send your New York Health Insurance quote request.**