North Carolina ( NC ) Health Insurance - Group And Individual Quote

Health Insurance for Individuals and Families

Click to apply for Celtic Basic Health Insurance

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Click to apply for a CelticSaver HSA

Click to apply for Short-Term Health Insurance

Health insurance quotes for individuals and families. The rate is dependent on age, gender, and health. We can help you with the information you need to make the best decision on your individual health insurance coverage.

Please take a few minutes to tell us about yourself. The information you provide is confidential and will help us customize your health insurance coverage.

Or you can call us at 704-342-3888 for a free consultation.

Name:
Address:
City:	State: Zip:
County:
Phone:
Work Phone:
Best Time to Call	Morning Afternoon Evening
Fax:
Email

WHO WILL BE INSURED?

Name	Age	Ht	Wt	DOB	Gender

GENERAL HEALTH INFORMATION

Are those to be insured fortunate to enjoy good health ?

Has any person to be covered lived in the USA for less than 12 months? Yes No
If yes, state the name of each person:

Additional comments:

Marital Status:
Do you smoke?
I used to smoke, but have not had a cigarette in
Does your spouse smoke?
My spouse used to smoke, but has not had a cigarette in

I would prefer a plan that features my current
Make multiple choices by holding down the
CTRL key and clicking the selection.

Do you need maternity coverage?
My hospital(s) of choice would be:
My current insurance is effective through
Current status of my health insurance:

Type of Coverage Desired;
Major Medical
PPO (Preferred Provider Organization)
Short Term Disability
Long Term Disability
Dental Care
Long Term Care (Assisted Living)
Medicare Supplement
Life Insurance

R.M. Beasley & Associates, Inc. is an independent authorized agency licensed to sell and promote products from Blue Cross and Blue Shield of North Carolina (BCBSNC). The content contained in this site is maintained by R.M. Beasley & Associates, Inc. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. BCBSNC products can be sold only to residents of North Carolina.
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(SM) Registered mark of the Blue Cross and Blue Shield Association

Health Insurance for Individuals and Families

GENERAL HEALTH INFORMATION

Are those to be insured fortunate to enjoy good health ? Select Yes No

Select Yes No

Select Yes No

Select Yes No

Select Yes No

Select Yes No

Select Yes No

Select Yes No

Are those to be insured fortunate to enjoy good health ?