All quotes are offered by Eck Agency, Inc a Kansas licensed agency.  They are quotes only, not contracts and are subject to underwriting by the respective companies.  If you live outside the state of Kansas, you will not receive a reply.  

You will be contacted by an agent with information and tentative rates 

Major Medical Insurance Quote Request

Primary Insured Spouse 
Name
Address
City/State  
Number of Children
Deductible
Other benefits
Prescriptions Doctor's Visits Wellness
Date of Birth
Gender
Tobacco Use
Are you, your partner, or a dependent currently pregnant?
Are you currently taking prescription medications?
Have you been hospitalized in the last 5 years?
Ever been treated for any of the following?
Heart Diabetes
Cancer Hepatitis
Stroke
Heart Diabetes
Cancer Hepatitis
Stroke

Contact Information
Home Phone
Work Phone
Cell Phone
Fax
Best Place to Contact Home Comments:
Work
Cell
Best Time to Contact Morning
Afternoon
Evening

 

All quotes and information offered by Eck Agency, Inc, a licensed Kansas agency.  Call 1-800-444-4911

Copyright © 2003 Eck Agency, Inc. All rights reserved  
Revised: December 12, 2006