Individual (Under 65) Health Insurance

We’ve assembled a condensed application sample to help you gather the information you’ll need to submit your application for health insurance.
Click the links below to download and complete the fillable PDF application. Note: don’t forget to review and sign our Notice of Privacy Practices (required by the State of Texas).


2017 Application Data and Privacy Notice – Under 65 Health Insurance (PDF)  


If you experience any trouble with these documents, please contact Abby Janca:
Office:  361-993-8888