Before you apply, be sure to view the American Medical Security Brochure  for your state below.  It contains important information regarding benefits, exclusions, limitations, renewability, and other terms of coverage.  Upon receipt of your application, American Medical Security will do a verification phone call to ask for any additional information they may need. 

There are Three Ways to apply for any American Medical Security plan:

1. The fastest and easiest way to apply with American Medical Security is to Apply Online.  Security of all online apps is protected by 128 bit Secure Socket Layer (SSL) encryption, the highest encryption available to most browsers.  The online application is available in the following states:
   
                 AZ, GA, IL, IN, LA, MI, MO, NC, NE, OH, OK, PA, SC, TN, UT, VA, and WI
   
   

*Online applications are not available in Colorado, Florida, or Texas.

2. The American Medical Security Tele-App* process is also a simple, fast and easy way to apply.
   
   

• To use the Tele-App process, simply call American Medical Security at 800-283-6708 (7 AM to 11 PM CST Monday-Friday, 7 AM to 6 PM CST on Saturday, closed Sunday).  You will speak directly to an underwriter, who will review your health history for the past five years.
  
  
• Once you have completed your interview process, the underwriter will instruct you as to what comes next.  If American Medical Security does not order medical records for your file, you will usually receive a decision on your application within 7 days.  If medical records are ordered, American Medical Security will usually issue a decision on your application within 7 days of receipt of your records from your doctor.
  
  
• You will be billed once you have been approved

* The American Medical Security Tele-App option is available in   
AR, AZ, GA, IA, IL, IN, MI, NE, OH, PA, TN, TX, UT, and WI.

3. To apply by fax or mail, select your state below to view the correct application .  When the Adobe Acrobat reader opens with the application, use the menu bar at the top to save the application to a file or simply print it out right from the reader.  (You may also email us and we will send you an application by fax or mail.)
   
   

Additional application documents:

• Supplementary Replacement 
• Colorado Self-Employed Determination