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BCBS of Michigan Online Application

UniCare Online Application

UniCare is a national organization dedicated to the delivery of quality health care plans and products. Providing managed care and specialty health care services throughout the United States, UniCare Life & Health Insurance Company is a subsidiary of WellPoint. UniCare offers a comprehensive array of health care plans and specialty products that preserve member choice at competitive prices.

UniCare recognizes that what works for one doesn’t necessarily work for another. That’s why our full portfolio of health, pharmacy, dental, life and disability benefits products can be tailored to meet your specific needs. Our focus is on putting our clients and their associates back in control of their health care and financial future. Through exceptional sales and account management staff who listen to our clients and their associates, we can create benefits that evolve over time to meet changing needs and add the most value.

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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SOLO HAP Online Application

SOLO HAP offers health plans for individuals and families not covered by employer health insurance. SOLO is affordable health insurance with flexible plan designs that include preventive care, emergency coverage and optional prescription benefits. HAP offers flexible products to meet the health needs and budget of Michigan residents. The health plan’s comprehensive PPO provider network includes more than 15,000 physicians across the state of Michigan.

HAP helps members improve their health with innovative preventive services, disease management programs and extensive online health resources. Through HAP Advantage, members receive preferred rates on chiropractic services, laser vision correction, Weight Watchers® meetings and fitness club memberships. iStrive For Better Health, HAP’s online health improvement program, offers members a free health risk assessment, six healthy lifestyle programs and rewards for reaching milestones in the program.

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)

cforms contact form by delicious:days

Assurant Health Online Application

Assurant Health has been in business since 1892 and is the brand name for products underwritten and issued by Time Insurance Company, John Alden Life Insurance Company and Union Security Insurance Company. Assurant Health is built on the cornerstone of consumer choice — providing ongoing flexibility and choices in health insurance financing solutions as well as choice of providers. As a leader in the individual insurance market Assurant Health’s legal entities, Time Insurance Company and John Alden Life Insurance Company, have each been assigned an A.M. Best rating of A- (Excellent). Union Security Insurance Company is rated A (Excellent).

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)

cforms contact form by delicious:days

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)

cforms contact form by delicious:days

Health Insurance Michigan | individual and group insurance solutions

BCBS of Michigan Online Application

UniCare Online Application

SOLO HAP Online Application

Assurant Health Online Application

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