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Home About Insurance

Health Insurance
Life Insurance
Critical Illness
Accident & Catastrophic
Vision & Dental

Partners

Elite RN
HRTU

Contact

Get a Quote Call +1 937-787-5082

Explore Insurance · Options for You and Your Family

Find the Right Coverage for You and Your Family

To help us find the best insurance plan for your needs, please provide some basic information about yourself and any dependents you would like covered. Your answers will help us understand your household’s coverage needs and compare suitable plan options. The more accurate the information you provide, the better we can recommend coverage that fits you and your family. After you complete the form, the next step is to book a consultation with us. During your consultation, we’ll review your information, discuss your coverage needs, and guide you through the insurance options that may be right for you and your family.

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+1 937-787-5082

Insurance Quote Request

Preliminary Insured Information Submission Form. This is not issuance of health insurance. You must review a formal application with a LIVE Health Insurance Agent to determine your needs and eligibility. NOTE: No Fees will ever be collected, unless by a licensed agent upon you authorizing a contract for health insurance services.

First Name *

Last Name *

Email *

Phone *

Address

Street Address *

City *

State *

Postal Code *

Health Insurance LIVE Quote Request

Insured Information

Primary Insured Full Name *

Gender *

Male

Female

Marital Status *

Single

Married

Tobacco? *

Yes

Primary DOB *

Height: Feet/Inches (e.g 5.4) *

Weight (e.g 52) *

Occupation *

List all prescribed medication taken, how often, for what reason, include current medical condition or medical history: including heart, stroke, cancer, injuries, ongoing treatments or treatment recommendations pending. Please type NONE if not applicable. *

Do you wish to apply a spouse for coverage? If no, Skip Next Page. *

Yes

Health Insurance LIVE Quote Request

Insured Information

Spouse Full Name

Gender (spouse)

Male

Female

Tobacco? (spouse)

Yes

Spouse DOB

Height: Feet/Inches (e.g 5.4) (spouse)

Weight (e.g 52) (spouse)

Occupation (spouse)

Dependent Info

If none, Click Next.

Number of dependents needing coverage:

Dependent 1 Full Name

Dependent 1 DOB

Dependent 1 Gender

Male

Female

Dependent 1 Tobacco

Yes

Dependent 2 Full Name

Dependent 2 Gender

Male

Female

Dependent 2 DOB

Dependent 2 Tobacco

Yes

Dependent 3 Full Name

Dependent 3 Gender

Male

Female

Dependent 3 Tobacco

Yes

Dependent 3 DOB

Dependent 4 Full Name

Dependent 4 DOB

Dependent 4 Gender

Male

Female

Dependent 4 Tobacco

Yes

Dependent 5 Full Name

Dependent 5 DOB

Dependent 5 Gender

Male

Female

Dependent 5 Tobacco

Yes

Dependent 6 Full Name

Dependent 6 DOB

Dependent 6 Gender

Male

Female

Dependent 6 Tobacco

Yes

Please list any dependents with any medical conditions and/or prescribed medication(s). List all prescribed medication taken, how often, for what reason, include current medical condition or medical history: including heart, stroke, cancer, injuries, ongoing treatments or treatment recommendations pending.

General Health Questions

Please answer to the best of your capability for accuracy in determining the best plan for you.

Are currently insured by a major medical plan, shared health plan, or Obamacare? *

Yes

Not Sure

List your current insurance providers name, (if applicable):

Provide your desired effective date. *

Are you or any person in your household pregnant or wanting to get pregnant? *

Yes

Yes, i would like to get pregnant

Not Sure

How ready are you in making a health care insurance decision? *

It is urgent that I get coverage and am ready to move forward.

I would like to schedule a virtual appointment to answer my questions.

I am currently shopping for rates.

How did you hear about us? (Provide name of person who referred you so we can thank them!)

Besides Health Insurance, what else would you like us to quote for you?

Dental and Vision

Life Insurance

Long Term Care

Medicare

SCHEDULE LIVE QUOTE NOW

IMPORTANT: Please be sure your spouse/partner (if applicable) is in attendance on the virtual call or ZOOM conference at the time of the appointment. Reserve 60 minutes for the call.

LIVE QUOTE Appointment Preparation *

I am prepared and able to ZOOM conference via my computer or phone.

I prefer a phone conference and DO have a computer.

I prefer a phone conference and DO NOT have a computer.

T&C *

I agree to the terms and conditions provided by the company. I consent to receive the occasional marketing messages from Kincaid Solutions LLC. You can Reply STOP to unsubscribe at any time.

I consent to receive SMS notifications, alerts & upcoming meeting details from Kincaid Solutions LLC. Message frequency may vary. Message & data rates may apply. Text HELP for assistance. You may reply STOP to unsubscribe at any time.

Independent insurance agency serving families and businesses across Ohio and 22 additional states. We compare plans from multiple trusted insurance carriers so you don't have to.

Insurance

Health Insurance
Life Insurance
Critical Illness
Accident & Catastrophic
Vision & Dental

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⌖ Dayton, Ohio · Licensed in 23 U.S. states

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Kincaid Solutions, LLC is an independent insurance agency licensed in Ohio and 22 additional U.S. states. Product availability, pricing, and eligibility vary by state, carrier, and applicant. This site does not constitute an offer of insurance; policies are underwritten by third-party carriers subject to their terms. Please contact us for state-specific details.