1. Customer
  2. Plans Plans
  3. Enrollment
  4. Confirmation
Samuel Handelman (ID: 234670)

Important Information (Updated: 4/1/17)
Effective immediately, in accordance with regulations, all Short Term Medical policies issued April 1, 2017 and later will have a maximum term date of less than three months.

Products underwritten by Time Insurance Company and National Health Insurance Company (including Short Term Medical) can be sold through this one consolidated platform!
Please email NatGenAHAgentServ@ngic.com with a subject line of “New Appointment Request” to access all the products National General Accident & Health has to offer.
To expedite your appointment request, please include your 6-digit Agent ID in the body of your message.

Quote any of our Short Term Medical or Supplemental plans here!

Demographics

Zip Code is required.

Invalid U.S. zip code.

No products are available in this state.

Per our license and/or appointment information, you are not currently authorized to sell in this state.

Please contact your sales representative at 888.376.3300 for any questions regarding this message.

Effective date is required.

Effective date must be tomorrow or later.

Effective date cannot be more than {{effectiveDateRange.QuotingDays}} days in the future.

Effective date cannot be on the 29th, 30th or 31st.

Invalid effective date.

  

Primary

Primary's gender is required.

Primary's date of birth is required.

Date of birth cannot be in the future.

Invalid birthdate.

*Smoker?

Primary's smoker status is required.

Spouse

Spouse's date of birth is required.

Date of birth cannot be in the future.

Invalid birthdate.

*Smoker?

Spouse's smoker status is required.

Dependents

Dependent's gender is required

Dependent's date of birth is required.

Date of birth cannot be in the future.

Invalid birthdate.

Remove Dependent Remove Dependent

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Answer "Yes" if you have used a tobacco/nicotine product within the last six months (religious or ceremonial uses do not apply)