INSURANCE ILLINOIS
Illinois Standard Health Application for Individual & Family Health Insurance Coverage For assistance in completing this application, please contact your insurance agent or the insurance company directly. For information about your health insurance rights under state and federal law, and other resources, please contact the Illinois Department of Insurance's Office of Consumer Health Insurance toll free at (877) 527-9431. INSTRUCTIONS: 1. Any information you provide in this application is confidential MoreFor assistance in completing this application, please contact your insurance agent or the insurance ... application and determines the effective date.) ... ILLINOIS STANDARD HEALTH APPLICATION FOR INDIVIDUAL & FAMILY HEALTH INSURANCE COVERAG Less
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