Idaho Maternity Plans

Idaho Supplemental Plan Information Request
Please fill out the form below so we may process your information and get you the most current application depending on your needs. After filling out the form below, press the SUBMIT Button to send your information. Thanks! (You may also call Customer Service Directly at (801) 999-8504)

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What State?

How can we help?

Last Name

Male First Name

Age

Female First Name

Age

# of Children

Street Address

City , Zip

, Idaho

Phone Numbers

Email Address

Current Health Plan(s)

Please Click next to the Plan(s) you are interested in purchasing:

You can choose one or both of the options below...
*	#	Monthly Rate	2 Day Benefit	4 Days Benefit	Application Notes:
	1	$103.98	$3,145	$4,345	Wife Only Covered
	2	Apx $95 *	$2,400	$4,550	Both Spouses must both be covered

* Option #2 Non-Smoker Rate Calculations
Female Ages Rate 18-24 $61.49 25-29 $65.97 30-34 $63.54 35-39 $61.66 40-44 $65.35 45-49 $74.97 50-54 $90.03	Male Ages Rate 18-24 $26.77 25-29 $29.80 30-34 $35.49 35-39 $43.38 40-44 $54.54 45-49 $70.21 50-54 $91.29
Example: Female 24, Male 29 = $61.49 + $29.80 = $91.29 See agent for exact rates - Smoker rates are slightly higher

Please Click Below to verify that you understand the following:

I am NOT Pregnant now and understand that no benefits will be paid for delivery within the first 10 months of the plan being in force.

Enter Questions or Comments Below,
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Please note that your information is kept completely confidential in compliance with the privacy policies dictated

by State Department of Insurance laws. You consent to only be contacted by an Agent for quoting purposes.

No information will be shared with any other company or organization for any reason. No personal information

is retained on this site at any time for any reason. Your agreement to be contacted will expire in 14 days. After

this date you will not be contacted unless you request further contact.

MaternityIdaho.com * (208) 352-0575

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