1. Customer
  2. Plans
  3. Enrollment
  4. Confirmation

General Questions

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A response to this question is required.

Eligibility questions

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A response to this question is required.

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Payment Method

Billing details

Please select a payment type.

Invalid routing number

Account number is required.

Account number must be numbers only.

Bank name is required.

Account owner's first name is required.

Account owner's last name is required.

Credit Card Logos

Invalid credit card number

Invalid expiration date

What's this?

Invalid security code/CVV

Cardholder's first name is required.

Cardholder's last name is required.

Authorization

Upon submission, ${{InitialPayment}} will be drafted immediately irrespective of policy effective date.

  

Your agreement to these terms is required in order to continue.



A valid 5 or 6 digit NHIC Agent ID is required


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There are errors in your enrollment information. Please review the information you entered and try again.




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Single Payment Details

Your non-refundable insurance premium will be withdrawn from your account in one lump-sum. The lump-sum withdrawal equals the total premium amount for the duration of your coverage.

If you have a L.I.F.E. Association Membership, your Association dues will be withdrawn from your account monthly, five days prior to your membership's monthly anniversary date.

Monthly billing details

The initial insurance premium and Association Membership dues for {{billedMonthlyProducts}} will be drafted upon submission of application, regardless of the plan's effective dates.

All subsequent payments will be withdrawn monthly from the customer's account five days prior to each plan's corresponding monthly anniversary date. For example if the applicant requests an effective date of 1/15/2017, the subsequent monthly withdrawal dates will be 2/10/2017, 3/10/2017, 4/10/2017 and so on.

If you purchase a package of consecutive Short Term Medical plans, the date your payments will be withdrawn for the subsequent plans may be subject to change. Your initial payment for any new subsequent plan can be withdrawn up to 15 days prior to your next subsequent policy’s effective date.

All payments will be processed from: Allstate Health Solutions 888-781-0585.

Your Credit Card Security Code/CVV helps safeguard your credit card purchases. This 3-digit number is printed on the back of your credit card.

Your Security Code/CVV is required during purchases on QuoteNatGen.com. We will not store your identification number, and cardholders are asked to enter it each time they make a purchase.

CVV


Your Security Code/CVV is the 3-digit number on the back of your card, near the signature panel.

You’re almost done.


The Member ID is {{MemberID}}.

(For Starmount policies, this number will be used only for the Allstate Health Solutions member website.)

Thank you for your business.


The submitted application is for a Allstate Health Solution Short Term Medical rewrite policy - before we can issue the new policy/member ID, we must review the application to verify eligibility.
Upon final approval, we will activate the policy and notify the insured the application is ready for verification.

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{{submissionResult.PlanType != 9 ? "Policy ID:" : "The Verification ID:"}} {{submissionResult.PolicyNo != '' ? submissionResult.PolicyNo : "Not Available"}}
Monthly Premium: {{submissionResult.TotalRate | currency}} Single Payment: {{submissionResult.TotalRate | currency}}
Agent / Enroller ID: {{submissionResult.EnrollerId}}
Effective Date: {{submissionResult.EffectiveDate}}
A policy number was not generated.
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Please note:
  • If the applicant does not have an active Association Membership, and it is required with the selected plan, the applicable LIFE Association Membership will be assigned, a notice will be emailed to the applicant, and their monthly bill will be adjusted accordingly.
  • If the applicant has any existing Allstate Health Solutions Supplemental products, in order to keep all policies under one member ID, all future payments for those policies and the new STM policy will be billed to the new payment information provided with this application.
Please contact your sales representative at 888.376.3300 for any questions regarding the above message(s).
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Your customer received an email from us that includes the link to VIPmemberbenefits.com/verify where they can go to read and e-sign their application acceptance verification. Or, if your client is with you, you can share the link below or complete the voice verification: Your customer must complete one of the options to finalize the application process.

1. Online e-signature Verification

  • Visit www.vipmemberbenefits.com/verify
  • Select "Register to setup a login"
  • Register your account by entering your Member ID {{MemberID}} and other credentials.
  • Select "Register"
  • Once registered and logged into the portal, a brief summary of the product, the terms and conditions, and the e-signature field will be displayed.
  • Please read the terms and conditions carefully to understand how your plan works.
  • Please verify your answers and read the authorization copy in its entirety.
  • Provide your electronic signature at the bottom of the page.
  • Click "Submit"
  • A confirmation message will appear at the top of the screen when the process is complete.

2. Voice Verification

Allstate Health Solutions markets products underwritten by National Health Insurance Company, Time Insurance Company, Integon National Insurance Company, and Integon Indemnity Corporation.

Health Insurance is defined as:

  • Group health plan
  • Individual Major Medical Plan
  • Short Term Medical plan with any carrier including with Allstate Health Solutions
  • Part A or Part B of title XVIII of the Social Security Act
  • Title XIX of the Social Security Act, other than coverage consisting solely of benefits under section 1928
  • Any type of Government assisted plan such as:
    • Chapter 55 of title 10, United States Code
    • A medical care program of the Indian Health Service or of a tribal organization
    • A state health benefits risk pool
    • A health plan offered under chapter 89 of title 5, United States Code
    • A public health plan, including health coverage provided under a plan established or maintained by a foreign country or political subdivision (as defined in regulations)
    • A health plan under section 5(e) of the Peace Corps Act (22 U.S.C. 2504(e)) and coverage under S-CHIP

Health Insurance is defined as:

  • Group health plan
  • Individual Major Medical Plan
  • Short Term Medical plan with any carrier including with Allstate Health Solutions
  • Allstate Health Solutions Foundation Health Plan or Hospital Expense Protection Plan
  • Part A or Part B of title XVIII of the Social Security Act
  • Title XIX of the Social Security Act, other than coverage consisting solely of benefits under section 1928
  • Any type of Government assisted plan such as:
    • Chapter 55 of title 10, United States Code
    • A medical care program of the Indian Health Service or of a tribal organization
    • A state health benefits risk pool
    • A health plan offered under chapter 89 of title 5, United States Code
    • A public health plan, including health coverage provided under a plan established or maintained by a foreign country or political subdivision (as defined in regulations)
    • A health plan under section 5(e) of the Peace Corps Act (22 U.S.C. 2504(e)) and coverage under S-CHIP