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Assurant Short-Term Application - Illinois


Assurant Health

Option A

Download Paper Application Form

pdf - 67KB
Download and Print the Assurant Health Short-Term Medical Insurance paper application form. Complete it by hand and mail it in (instructions included).

Option B

Send Application via Email or Regular Mail

Instruct us how and where you want us to send you the Assurant Health Short-Term Medical Insurance application form.

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