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Step 1

Basic Information

Type Of Coverage Needed *

ZIP / Postal Code *

Primary's DOB *Date of Birth

Month

Day

Year

Primary's Gender

Age & Gender For Additional CoveredAdd ages & gender for all those needing coverage.

Step 2

Coverage Needs

Do you have any pre-existing conditions that require coverage?YesNo

Do you need prescription drug coverage? *YesNo

Section 3

Financial Considerations

What best describes your work situation? *Self-employedSmall business owner1099 contractorW2 employeeNot currently working

What’s your estimated yearly household income? *Helps determine if you qualify for government discounts.Less than $30,000$30,000 – $55,000$55,000 – $100,000Over $100,000

When do you need coverage to start? *ASAPWithin 30 daysIn a few monthsNot Sure

Prescriptions, Treatments, or Health ConditionList any Prescriptions, Treatments, or Health Conditions that require coverage

Contact Information

Where Can We Send Your Quotes?

Name *

Mobile Number *Get Your Plan Options via Text

Email Address

By checking this box, you agree to receive automated text (SMS) messages from Lane Private Medical Insurance regarding your quote request, plan options, and important updates. Message frequency varies. Standard message and data rates may apply. Consent is not required for purchase. Reply HELP for assistance or STOP to opt out at any time.

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Step 1

Basic Information

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🔎 See Exclusive Health Plans Not on the Marketplace!

Exclusive Plans.
Lower Costs.
See Your New Rate.