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Apply
Online or Print Out and Mail or Fax Your Application
Please note
that all applications will be submitted in the name of Wiley Long, the
president of HSA for America.
If you have already been working directly with one of our advisors, then that
person will be noted in our system as your personal contact.
To Apply
Online
The fastest
and easiest way to get your coverage in force is to Apply
Online (Internet Explore required), using the link below. Gather
the following information before you start the application in order to speed
the process:
- Your doctors’
names, addresses, and phone numbers
-
Medications you currently take or recently took, including dosage and frequency
- Dates
of hospitalization
-
The name of the plan for which you are applying
-
Your requested effective date
-
Your credit card information to cover the initial premium
Internet
Explorer required
For
security, Aetna uses 128-bit Secure Socket Layer (SSL) encryption, the
highest encryption available to most browsers, with a public key length of 1,024
bits.
To Print
Out Your Application
Simply run an
instant quote, then click "Apply"
next to the plan you are interested in and select "download an application."
When the Adobe Acrobat reader opens with the application, use the menu bar at
the top to save the application to a file or simply print it out right from
the reader. Follow
the instructions on the first page and complete the entire application.
Please fill
out the application completely and include all pages. Any
unanswered questions will delay the processing. If you have any questions
about filling out the application, call application processing department at
866-749-2039, or email us at info@HSAforAmerica.com,
leave your name and phone number, and someone from our office will call you
back and answer any application questions you have. Fax
your application toll-free to 1-888-771-0010. Or Mail it to:
HSA
for America
1001-A East Harmony Road, #519
Fort Collins, CO 80525
Initial
Premium
Use a credit
card or check to pay the initial premium. Make the check payable to “Aetna”.
Payment must be submitted at the time of application. The check
is not deposited (nor the credit card charged) until the application has been
approved.
Note:
All policies come with a money-back guarantee. After receiving
your policy, you have 10 days to review it. If for any reason you decide
not to keep the policy, you will receive a full refund of your initial premium.
Remember that you also have access to the guaranteed lowest
life insurance rates available, with easy online quotes and applications.
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