How to Apply

Please note that all applications will be submitted in the name of Wiley Long, the president of HSA for America.  If you have already been working directly with one of our advisors, then that person will be noted in our system as your personal contact.

Before you apply, be sure to view the Golden Rule brochure.  It contains important information regarding benefits, exclusions, limitations, renewability, and other terms of coverage.  To see the brochure, please run an instant quote and click on the plan details.

Apply Online:

The fastest and easiest way to apply is to Apply Online.  In order to Apply Online for any plan with Golden Rule Insurance Company, you will need to run an instant quote.  When you see the plan you would like to apply for, simply click the APPLY button next to the quote and you will enter the online application process.  

Gather the following information before you start the application in order to speed the process:

1. Your doctors’ names, addresses, and phone numbers
2. Medications you currently take or recently took, including dosage and frequency
3. Dates of hospitalization
4. The name of the plan for which you are applying
5. Your requested effective date
6. Your credit card information to cover the initial premium

For security, Golden Rule uses VeriSign certified SSL 128 bit encryption.

Apply by Fax or Mail:

Follow the steps and you can apply within minutes.

To apply via fax or mail for any plan with Golden Rule Insurance Company, just follow the instructions below:

1. Select your state below to view the correct PDF 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 fill out our Application Request Form and we will send you an application right away.)
   

AVAILABLE STATES Alabama Georgia Michigan Pennsylvania Arizona Indiana Missouri South Carolina Arkansas Illinois Nebraska Tennessee Colorado Iowa North Carolina Texas Connecticut Kansas Ohio Virginia Florida Kentucky Oklahoma Wisconsin - Louisiana - -

2. Simply follow the instructions on the first page to complete the application.
   
   
3. If paying by credit card or bank draft, you may fax your application toll-free 866-284-0082.
   
   
4. If applying by mail, send the complete application along with first payment to our office.
   
   
5. You may apply for a supplemental accident plan with a $100 deductible on our Accident Plan** page. 
   ** This plan is not associated with Golden Rule Insurance Company.

Please fill out the application Completely.  Any unanswered questions will delay the processing.  If you have any questions about filling out the application, email us at info@HSAforAmerica.com, leave your name and phone number, and someone from our office will call you back and answer any application questions you have.

Important:  Golden Rule will charge your first month’s premium immediately upon receipt of the application.

Note:  After receiving your policy or certificate, you have 10 days to review it.  If for any reason you decide not to keep the policy, you will receive a full refund of your initial premium.