Get an application you can print out and fax for Chesapeake Life's American Health Shield (All forms are Acrobat 'pdf' forms) To APPLY OnLINE (or Get a Quote) Chesapeake Life's American Health Shield Use Information Request Form to get quote and agent reply (preferred if you do not wish to purchase coverage 'online') (if you'd like some 'personal' attention and interaction with a real human)
NOTE: Rates for temporary insurance are the same, regardless of where you go to purchase it. Our licensed full-time internet agents are here to provide full support for any policy you purchase from this site. ELIGIBILITY ...is determined by the state where you live, and your ability to answer "NO" to the few questions on the application form. AVAILABILITY ...Temporary Health Insurance policies will provide coverage for a new illness or injury at any doctor or hospital in all 50 U.S. states as well as in Canada. Policy availability depends on the state where an applicant lives. The "American Health Shield" policy is available in 35 states plus the District of Columbia (see AHS table of states below) Temporary insurance policies are NOT available to persons who live in: MA... NJ... NY... VT
AVAILABILITY ...Temporary Health Insurance policies will provide coverage for a new illness or injury at any doctor or hospital in all 50 U.S. states as well as in Canada. Policy availability depends on the state where an applicant lives.
The "American Health Shield" policy is available in 35 states plus the District of Columbia (see AHS table of states below)
Current U.S. government reports state there are 43+ million Americans under the age of 65 who do not have medical coverage. Most of these are people who are temporarily uninsured due to a job change, layoff, relocation, or recent College graduation. If you are temporarily uninsured, Short Term Health Insurance is an option that you should consider.
COVERAGE HIGHLIGHTS:
NOTE: This program provides coverage throughout the USA and Canada.
(return to top of page) Print out the application by clicking on the state where you live in the table below (if your state is not listed, then the "American Health Shield" plan is not available to you). Click on "brochure only" to obtain the plan brochure document.
(If you live in: ID... KS... ME... ND... NH... OR... SD... WA... use the Information Request Form to request a quote, and we will e-mail you information for a temporary health insurance plan that would be available to you.)
1. Select and click on the state where you live from the table above (if your state is not listed, then "American Health Shield" temporary insurance is not available in the state where you live)
2. Print out the brochure application 3. Complete the application (answer the few questions.... if you need assistance, or need help calculating the premium, call the toll-free number provided on the application) NOTE: When you apply for this policy, it is best to indicate that you want 180 days of coverage and choose the "monthly" premium payment method because the policy cannot continue longer than the maximum benefit period requested on the application form. There is no difference in the cost of the policy... and you will be able to discontinue the policy at the end of any coverage month by sending a written request to stop the coverage. 4. If using a VISA or MasterCard, fax your completed application to:
5. If paying the premium by check/money order, please make your check payable to "Chesapeake Life." and mail to:
Coverage can begin as early as the day after your application is faxed or mailed (mailed applications must have a legible post office cancellation mark on the envelope)
(return to top of page) Short Term Health Insurance policies provide coverage throughout the USA and Canada, however the Chesapeake Life "American Health Shield" temporary health insurance policy is presently not available to persons whose address is in the states of:
A Special Note To New College Graduates and their Parents... If a Graduate is over age 19, medical coverage under a parent's policy usually ends immediately as soon as "full-time student" status ends... and with many plans, this happens on Graduation Day.
(This also occurs any time a student's course load drops below the school's definition of "full-time student"... and most colleges require you to take 12 or more credits to be considered "full-time").
Too often, parents and students discover this too late... after there has been an accident or illness! Don't let it happen to you! You can obtain economical Temporary Health Insurance coverage that will bridge the gap between graduation and the start of a new job, or for any other circumstances that cause breaks in your "full-time student" status. Coverage is available for as little as 30 days or for as long as 6 months.
Print out a copy of your state's application/brochure, or use the Information Request Form (below) to request a 'no-obligation' rate quote for "Temporary Health Insurance" coverage.
Information Request Form (this is NOT an application for insurance): (return to top of page)
Use this form (please fill in ALL the blanks) to request rates/information via this Web page....
(Your personal information will be kept confidential and will NOT be used for any other purpose)
Please provide birth dates and gender of all persons to be covered.. use 'remarks' area.
NAME... first-middle-last.. your FULL name:
E-MAIL ADDRESS... essential:
GENDER: Male Female DATE OF BIRTH: mm/dd/yy (provide dependents birth dates below)
CITIZEN OF:
FULL STREET ADDRESS & ZIP CODE.. as would be used on an application:
DEDUCTIBLE PREFERRED: $250 $500 $1,000 $2,000 ... some deductibles not available in all states
DURATION OF COVERAGE DESIRED?... 30 - 180 days: 180 days 150 days 120 days 90 days 60 days 30 days days.
DATE YOU WOULD LIKE COVERAGE TO BEGIN: mm/dd/yy
Go back to CHAMPION INSURANCE HOME PAGE
Click HERE to send us e-mail ...make "INSURANCE INQUIRY" (all caps) the subject of your e-mail