Annual Comprehensive Review

Annual Insurance Policy Review
Could You Be Saving Money?

Every year ColoHealth clients are offered their Annual Comprehensive Policy Review, at which time we will research competitive options to make sure they are in the plan that offers them the best value.  As independent brokers, our loyalty is to our customers.

If you would like a complementary review of your current plan compared to your best options, fill out the form below.  One of our advisors will do some preliminary research, and someone from our office will call to schedule a time for you to speak with them about your options.

All information will be kept confidential, and is requested solely for the purpose of providing you rate and policy information (see our Privacy Statement).  All consultations are backed by our Extremely Satisfied Guarantee.

Please note: ALL information must be filled out completely before we can confirm your appointment.

Contact Information (* Required)  First Name: *    Last Name: *    Email: *    Phone: *    Fax:   Street Address: *    City: *    State: *   AL AR AZ CA CO CT FL GA IA ID IL IN KS KY LA MI MN MO MT NC NE NV OH OK OR PA SC SD TN TX UT VA WA WI WY  * Plans are only available in the listed states.  Zip Code: *    Date of Birth: *   Insurance Information Primary:* Sex Smoker? Height Weight Select... Male Female Select... No Yes    Current Insurance Information:*   Insurance Comp:   Monthly Premium:   Deductible:  Additional Family  Members: Sex DOB Smoker? Height Weight Select... Male Female Select... No Yes Select... Male Female Select... No Yes Select... Male Female Select... No Yes Select... Male Female Select... No Yes Select... Male Female Select... No Yes  Is any family member currently pregnant? (Plans cannot be written until after the baby is born. When is the due date?):   What Type of Plan are you looking for? (HSA, CoPay, Low Cost, ECT) Please say if you have a specific plan in mind. Do you have a general idea of what type of coverage you are interested in?  For example, are you looking for a plan that qualifies to work with a Health Savings Account, or a traditional plan with co-payments for doctor visits and prescriptions, or perhaps a low-cost basic plan that provides you with catastrophic coverage?   Does anyone that will be applying for coverage have diabetes, heart disease, or any other pre-existing medical conditions?   Is anyone currently taking medication? (If so, what is the reason, and what is the medication?)   When would you want your new plan to become effective?    Have you reviewed your instant quotes (Y/N):   Select... No Yes   Instant Quote Engine If NO:  If you have internet access, we recommends you take a moment to review your instant online quotes, which are available at www.ColoHealth.com.  This will give you a general idea of what is available, and will help to ensure that you make the most of your appointment time. Comments:   Who referred you to ColoHealth?   Select... Google Yahoo MSN Online (general) Yellow Pages Referral Other