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 for a health insurance plan with World, be sure to view the brochure for the plan you are applying for.  It contains important information regarding benefits, exclusions, limitations, renewability, and other terms of coverage:

HD Advantage    Value Advantage

The fastest and easiest way to get your coverage in force is to Apply Online, using the link above.  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

If you do not wish to Apply Online, simply follow the paper application instructions below:

1. Select your state below to view the correct application PDF.  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 Indiana Nebraska South Carolina Arkansas Iowa Nevada Tennessee Arizona Kansas North Carolina Texas Colorado Louisiana Ohio Virginia Florida Michigan Oklahoma Wisconsin Georgia Missouri Pennsylvania Wyoming Illinois Montana - -

2. Follow the instructions on the application.
   
   
3. Fax the completed application to us at (866) 284-0082, or mail it along with first payment to the address below.  The initial premium can be paid with a check or credit card.  The premium can then be paid via quarterly, semi-annual, or annual billing, or via monthly bank draft or credit card.  The bank draft will occur on the premium due date each month.
   
   
4. After we review your application we will email you a World verified quote that you must sign and send back to us before World can finish processing your application.

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.

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.