Request Form – Start Here to Submit a Request

Health Connect Insurance Agency is an independent brokerage firm and is not a Covered California state or federal marketplace or other website. It does not have access or connection to the Covered California state marketplace or federal exchange. This website is owned and operated by Health Connect Insurance Agency, a licensed insurance agency, CA license# 0L29729. Applications or quotes for health insurance made through Health Connect Insurance Agency are only valid where licensed with the state and appointed with the appropriate carrier.

This Website is Owned and Operated by Health Connect Insurance Agency, a licensed insurance agency. Invitations for applications for Insurance are made only where licensed and appointed. Health Connect Insurance Agency’s License Information can be found by conducting a name search and insurance.ca.gov. By clicking the “Start My Quote” button on the “home” page, and “Submit” on the “Individual-and-family-plans” page, and submitting this form, you expressly consent to Health Connect Insurance Agency (“Company,” “We,” or “Us”), our agents, representatives, its partners or affiliates, or anyone calling on the company’s behalf to receive telemarketing sales calls, whether automated, autodialed, prerecorded, or from an automated system for the selection or dialing of telephone numbers, or using prerecorded messages or artificial voice, or from an automated system for the selection or dialing of telephone numbers, SMS messages (including text messages), email (using any email address you have provided to us), and by postal mail, even if you are on a state or federal Do Not Call and/or Do Not Email registry. Automated messages may be played when the telephone is answered, whether by you or someone else. You consent to receive these communications at the specific phone number you provide to us on this form.

This website does not provide information about health insurance plans, nor does it allow visitors to obtain insurance quotes on this website. If you provide your consent and information, a licensed agent from Health Connect Insurance Agency will contact you to offer a plan through Covered California.

By clicking the “Start My Quote” button on the “home” page, and “Submit” on the “Individual-and-family-plans” page and submitting this form, you: (i) verify that the contact information entered is correct and is your personal information and that you are over 18 years of age, and (ii) that you are providing your electronic signature and your prior express written consent to receive the communications listed above. You are not required to directly or indirectly sign this agreement or to agree to enter into such an agreement as a condition of purchasing any property, goods, or services. You may revoke consent by contacting: [email protected]. You certify, warrant and represent that the telephone number that you provide in this form is your contact number and that you are permitted to receive calls at this number. You agree that if you provide telephone number(s) for which you are not the subscriber, or for the purpose of initiating a legal demand or legal action, you agree to indemnify Company for any and all costs and expenses, including reasonable attorneys’ fees incurred as a result of Us contacting or attempting to contact you at the number(s).