You can insure any one of the following combinations of family
members:
• Single adult
• Couple - you and your spouse
• Family - you, your spouse and one or more children
• Single parent household - parent and one or more children
• Single child
• More than one child
The gender and age of each person is also required.
When enrolling a child and/or children only, enter the ages in
the child boxes. Enter any additional children in the appropriate
child blocks. Rate computations for child/children only plans
vary by carrier. Some insurance companies have specific rates
for youth plans and other insurance companies base rates for children
on the age of either the youngest or oldest child.
Age - The age for each family member that is to be insured.
Tobacco Usage - For each adult that is to be insured, please
check the box if they are a tobacco user. By default, all adults
are assumed to NOT be tobacco users
