• Fort Dodge
  • Manson
  • Johnston
  • Arnolds Park

Quote Request for Private Health Insurance

Step 1 of 3

  • MM slash DD slash YYYY
  • Policyholder Information

  • MM slash DD slash YYYY
  • Spouse and/or Dependent Information

  • First NameLast NameDate of BirthGenderTobacco Use 
    Use the + icon at the end of each row to add additional rows as needed
  • Current Coverage

  • Income Information

    You may be eligible for a subsidy/premium tax credit to help pay your healthcare premium. To determine if you are eligible please provide us with your estimated total household income for 2023.

Please note that submissions made via this website do not constitute a binding agreement of any kind. Coverage or changes in coverage are not effective or binding until you, or any party involved, receive official notice from an authorized representative of KHI Solutions or your insurance company. Misstatements or omissions of relevant information by the prospect/client can lead to price variation or even declination or rescission of coverage.