bluecross-quotes.marketplace-plans.com
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Submission: On December 06 via api from US — Scanned from US
Submission: On December 06 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
POST
<form method="POST">
<input id="Email" name="Email" type="hidden" value="">
<div class="fields">
<div class="lp-pom-form-field drop-down" id="container_state">
<label class="main lp-form-label" for="state" id="label_state" style="height: auto;">
<span class="label-style">State *</span>
</label>
<select id="state" class="ub-input-item single form_elem_state" required="" data-val="true" data-val-required="The State field is required." name="State">
<option value="">Select a State</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select>
</div>
<div class="lp-pom-form-field drop-down" id="container_plan_type">
<label class="main lp-form-label" for="plan_type" id="label_plan_type" style="height: auto;">
<span class="label-style">Plan Type</span>
</label>
<select id="plan_type" class="ub-input-item single form_elem_plan_type" data-val="true" data-val-required="The PlanType field is required." name="PlanType">
<option value="Individual">Individual</option>
<option value="Family">Family</option>
<option value="Medicare">Medicare</option>
</select>
</div>
<div class="lp-pom-form-field drop-down" id="container_gender">
<label class="main lp-form-label" for="gender" id="label_gender" style="height: auto;">
<span class="label-style">Gender *</span>
</label>
<select id="gender" class="ub-input-item single form_elem_gender" required="" data-val="true" data-val-required="The Gender field is required." name="Gender">
<option value="">Select your Gender</option>
<option value="Male">Male</option>
<option value="Female">Female</option>
</select>
</div>
<div class="lp-pom-form-field single-line-text" id="container_age">
<label class="main lp-form-label" for="age" id="label_age" style="height: auto;">
<span class="label-style">Age *</span>
</label>
<input id="age" type="number" class="ub-input-item single text form_elem_age" required="" data-val="true" data-val-range="The age must be between 18 to 99" data-val-range-max="99" data-val-range-min="18"
data-val-required="The Age field is required." name="Age" value=""><input name="__Invariant" type="hidden" value="Age">
<span class="text-danger field-validation-valid" data-valmsg-for="Age" data-valmsg-replace="true"></span>
</div>
<div class="lp-pom-form-field single-line-text" id="container_first_name">
<label class="main lp-form-label" for="first_name" id="label_first_name" style="height: auto;">
<span class="label-style">First Name *</span>
</label>
<input id="first_name" type="text" class="ub-input-item single text form_elem_first_name" required="" data-val="true" data-val-regex="Invalid First Name" data-val-regex-pattern="^[A-Za-z]+(?:\s[A-Za-z]+){0,2}$"
data-val-required="The First Name field is required." name="FirstName" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="FirstName" data-valmsg-replace="true"></span>
</div>
<div class="lp-pom-form-field single-line-text" id="container_last_name">
<label class="main lp-form-label" for="last_name" id="label_last_name" style="height: auto;">
<span class="label-style">Last Name *</span>
</label>
<input id="last_name" type="text" class="ub-input-item single text form_elem_last_name" required="" data-val="true" data-val-regex="Invalid Last Name" data-val-regex-pattern="^[A-Za-z]+(?:\s[A-Za-z]+)?$"
data-val-required="The Last Name field is required." name="LastName" value="">
<span class="text-danger field-validation-valid" data-valmsg-for="LastName" data-valmsg-replace="true"></span>
</div>
<div class="lp-pom-form-field single-line-text" id="container_phone_number">
<label class="main lp-form-label" for="phone_number" id="label_phone_number" style="height: auto;">
<span class="label-style">Phone Number *</span>
</label>
<input id="phone_number" type="tel" class="ub-input-item single text form_elem_phone_number" required="" pattern="^(\+?1[ -]?)?\(?[2-9]\d\d\)?[ -]?[2-9]\d\d[ -]?\d{4}$" data-val="true" data-val-required="The PhoneNumber field is required."
name="PhoneNumber" value="" inputmode="text">
</div>
<div class="lp-pom-form-field drop-down" id="container_do_you_smoke">
<label class="main lp-form-label" for="do_you_smoke" id="label_do_you_smoke" style="height: auto;">
<span class="label-style">Do you smoke?</span>
</label>
<select id="do_you_smoke" class="ub-input-item single form_elem_do_you_smoke" data-val="true" data-val-required="The Smoke field is required." name="Smoke">
<option value="No">No</option>
<option value="Yes">Yes</option>
</select>
</div>
</div>
<button class="lp-element lp-pom-button" id="lp-pom-button-359" type="submit">
<span class="label">
<strong>Get My Free Quotes >></strong>
</span>
</button>
<input name="__RequestVerificationToken" type="hidden" value="CfDJ8HXCw6a5km9OsHgca1THiCl8XVMKKM28NU9Lj80STRTwCGjKuOJGyG-KpXLhMPQ8y0ZRb5Y936kCA-DB4camlbMc-GgwWTFVcDS2hML3NhA8ZAWFRBBvYEloCid4qG-nEtF4Jjj34REHwq3nHYLReVM"><input type="hidden"
name="xxTrustedFormToken" id="xxTrustedFormToken_0" value="https://cert.trustedform.com/047c0f285aa12bfeaf8727f9f808e284c9afa676"><input type="hidden" name="xxTrustedFormCertUrl" id="xxTrustedFormCertUrl_0"
value="https://cert.trustedform.com/047c0f285aa12bfeaf8727f9f808e284c9afa676"><input type="hidden" name="xxTrustedFormPingUrl" id="xxTrustedFormPingUrl_0"
value="https://ping.trustedform.com/0.C7YiyJL18ehPir7Z-FDl1bAI3FpL3tfNF7rnlv1Mmt70n6hdaDR0I2ixnx7aNnitEqjCN06c.o2rgBOmbkluXh5uaQYJ2VA.qgmUUG50pcy9WomJKhv9dA">
</form>Text Content
Aetna Cigna BCBS Horizon United and more! and more! Aetna Cigna BCBS Horizon United and more! Congratulations! You Qualify for NEW 2024 Health Plan Discounts Compare ACA plans vs. short term plans and fixed indemnity. Fast & free, no obligation quotes for you and your family. Compare with Short Term Plans & Fixed Indemnity Compare Health Plan Rates... FAST! Individual Plans Family Plans Medicare Plans COMPARE QUOTES IN JUST 1 MINUTE State * Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Plan Type Individual Family Medicare Gender * Select your Gender Male Female Age * First Name * Last Name * Phone Number * Do you smoke? No Yes Get My Free Quotes >> By clicking the Get My Free Quotes button and submitting this form, I agree that I am 18+ years old and I provide my e-signature / electronic signature expressly consenting to receive emails, calls, postal mail, text messages and other forms of marketing communication regarding Medicare Insurance, or other offers from the listed companies and agents to the number(s) I provided, including a mobile phone, even if I am on a state or federal Do Not Call and/or Do Not Email registry. The list of companies participating are subject to change. I will receive calls and/or texts from multiple companies in the list. Such calls and text messages may use automated telephone dialing systems, artificial or pre-recorded voices. I understand my wireless carrier may impose charges for calls or texts. I understand that my consent to receive communications is not a condition of purchase and I may revoke my consent at any time by visiting here . Congratulations! You Qualify for NEW 2024 Health Plan Discounts Health Enrollment is NOW OPEN - Hurry Before It's Too Late! Compare Health Plans Across the United States Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Congratulations! You Qualify for NEW 2024 Health Plan Discounts Plus many more including short term & fixed indemnity plans Call Toll-Free for a Health Plan Quote: CLICK TO CALL FOR INSTANT PHONE RATES × The Health Plan Hotline is OPEN CALL NOW - No Hold Times! Current Hold Time: 0 Minutes HURRY AND GET YOUR 2024 HEALTH PLAN SAVINGS No Hold Times & Immediate Quote! Copyright © 2023 Marketplace-Plans.com | All rights reserved | 601 Jefferson Road, Suite 200, Parsippany, NJ 07054 Marketplace-Plans.com is privately owned & operated. Requests for applications for health plans on Marketplace-Plans.com are made through our licensed agents or our Partners, only where licensed and appointed. Licensing information can be found here . Submission of your information to our website constitutes your expressed permission for an agent to contact you with additional information about the cost and coverage details of the health plans that we write. Possible health plan options include, but are not limited to Major Medical Plans, Short Term Plans, Fixed Indemnity Plans, Life Plans and more. Descriptions are for informational purposes only and subject to change. Health plans may not be available in all states. For a complete description, please call "TTY 711" to determine your eligibility and to request a copy of the applicable policy. Marketplace-Plans.com is not affiliated with or endorsed by the United States government or the federal Medicare program. By using this site, you acknowledge that you have read and agree to the Terms of Use . and Privacy Policy . This website may not display all data on Qualified Health Plans being offered in your state through the Marketplace website or the federal Medicare program. This is not a complete listing of plans available in your service area. To see all available data on Qualified Health Plan options in your state, visit your state Marketplace website, go to the Health Insurance Marketplace website at https://www.healthcare.gov or consult https://www.medicare.gov . Submitting this form does NOT affect your current enrollment, nor will it enroll you in a Medicare Advantage plan, Medicare Prescription Drug plan, Medicare Supplement Plan, or any other Medicare plan. Lead Generation Inc. is independent of the Medicare program and is neither associated with nor endorsed by The Centers for Medicare & Medicaid Services (CMS) or any other governmental agency. The plans represented on Marketplace-Plans.com are Medicare Advantage HMO, PPO and PFFS organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal. If you are paying Medicare Part B premium, you must continue to pay it to maintain coverage. About Us • Licenses • Contact Us • Privacy Policy • Terms of Use • Do Not Contact Me