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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, please view the PacifiCare
brochure 
for Plan Provisions, Limitations & Exclusions, and State
Variation information:
Apply
Online
The
quickest and easiest way to apply is to use Pacificare’s
secure online application. The information
is transmitted directly to the underwriting department,
and we are also notified. We will keep you informed
on the status of your application, and let you know as soon
as you are approved.
Gather
the following information before you start the application
in order to speed the process:
-
Your doctors’ names, addresses, and phone numbers
-
Medications you currently take or recently took, including
dosage and frequency
- Dates
of hospitalization
-
The name of the plan for which you are applying
-
Your requested effective date
-
Your credit card information to cover the initial premium
Apply
by Mail or Fax
You
may also fax or mail in an application. Simply open
the Pacificare
Application ,
and print a copy. Follow the instructions and fax
the application to us at 866-284-0082, or mail it
to the address below. (If you are unable to print an application,
email us and
we will send you one in the mail.)
Note:
All policies come with a money-back guarantee.
After receiving your policy, 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.
Remember that you also have access to the guaranteed lowest
life insurance rates available, with easy online quotes
and applications.
CA
License #: 0E39302
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