Family Members To Be Insured


You can apply for any one of the following combinations of family members:
• Single adult
• Couple - you and your spouse
• Family - you, your spouse and one or more children
• Single parent household - parent and one or more children
• Single child
• More than one child

The gender and age/date of birth of each person is also required.

When entering a child and/or children only, enter the age/date of birth in the child boxes. Enter any additional children in the appropriate child blocks. Rate computations for child/children only plans vary by carrier. Some insurance companies have specific rates for youth plans and other insurance companies base rates for children on the age of either the youngest or oldest child.