Apply Online

Welcome to the online health insurance application for The Focus Group. Within 5 minutes you can apply for coverage and be on your way. You’re in good hands! Representing over 104 insurance companies, we are your client advocate. We work for you. Not the insurance company. The Focus Group does not share, sell, or store your information.

Let’s get started!

Please Select Plan:

PERSON(S) TO BE INSURED

Primary First & Last Name(required)
Gender:(required)
Date of Birth:(required)
Height Ft:(required)
Height In:(required)
Weight:(required)
Social Security Number:

SPOUSE INFORMATION

Spouse First & Last Name
Spouse Gender:
Spouse Date of Birth:
Spouse Height Ft:
Spouse Height In:
Spouse Weight
Spouse Social Security Number:

DEPENDENTS

Yes No
Dependent 1 Name:
Dependent 1 DOB:
Dependent 2 Name:
Dependent 2 DOB:
List Additional Dependents:

PERSONAL INFORMATION

Resident Address:(required)
City:(required)
State:(required)
Zip:(required)
Phone Number:(required)
Email Address:(valid email required)

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Tags: Apply for Health Insurance Online, Apply Online, health insurance, Online Application

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