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Short Term Medical Insurance &
Student Select Medical Insurance

Effective dates.

Short Term Medical Plan
There are now two options for applying for short term medical. (You can do either method on-line if you wish.)

1. Apply on-line with a credit card. OR
2. Print and mail form with payment.

To Apply on-line (click here), you must enter an agent code number when prompted. This is my agent number M8951

To Mail in your application you may follow the same process on-line, simply choose the pay by check option. This will generate a form that you can print and sign. This is very convenient since the form will be filled out with your information and premium based on the data you have already input.

Special Notice: READ THESE INSTRUCTIONS BEFORE PROCEEDING
(it will save you some time).

Student Select Medical

There are now two options for applying for short term medical. (You can do either method on-line if you wish.)

1. Apply on-line with a credit card. OR
2. Print and mail form with payment.

To Apply on-line (click here), you must enter an agent code number when prompted. This is my agent number M8951

To Mail in your application you may follow the same process on-line, simply choose the pay by check option. This will generate a form that you can print and sign. This is very convenient since the form will be filled out with your information and premium based on the data you have already input.

EFFECTIVE DATE: Coverage is effective no sooner than midnight the date of the post mark by the US Postal Service. You may choose the effective date by filling it in on the application. It can be no earlier than the day following the canceled post mark.

PREMIUMS: 

• May be paid in full or on a monthly basis. 
• May be paid by check or credit card.  If paying by credit card, be sure to sign the card authorization box.

This link will take you to the Short Term Medical web site.
This link will take you to the Student Medical web site.

PLEASE SEND ME A NOTE IF YOU HAVE ANY QUESTIONS ABOUT HEALTH PLANS FOR YOUR BUSINESS. ANY SPECIFIC QUESTIONS ABOUT  SHORT TERM and STUDENT SELECT PLANS SHOULD BE DIRECTED TO FORTIS.  I will assist you if you cannot get an answer to your questions. 

Notice; Every effort is made to keep these applications up to date. Revisions are posted as soon as we receive proper notification. For the latest information the insurance company web sites should be consulted. We are not responsible for changes implemented by the insurance companies or fluctuations in their rates.

Thank you for visiting my web site,

Randy