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Arizona Health Insurance Quotes for Individuals and Families

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All fields requiredGeographic Information

Enter your Zip Code : 
State :  County : 

All fields requiredPlan Detail

Coverage Type :  Long Term

All fields requiredApplicant Detail

Type of Application



If you need coverage for just yourself.


If you need coverage for a combination of family members that includes at least one adult family member.

  Child(ren) Only

If you need coverage for your child or children only. Children 18 and under can be included on this coverage type.


Date of Birth



Effective Date of Coverage

Select the date you would like coverage to begin from the list below. Please note that your date options are determined by the date of your qualifying event(s) listed above.

Requested coverage
effective date:


Qualifying Events for Special Enrollment Periods
for Individual and Family Plans

Please check the box next to any Qualifying Event(s) that happened within the last 60 days:

  1. The qualified individual, or his or her dependent, loses minimum essential coverage, which could be due to one of the following reasons (not including voluntary termination or termination due to failure to pay premiums):
    1. The death of the covered employee.
    2. The termination (other than by reason of such employee's gross misconduct), or reduction of hours, of the covered employee's employment.
    3. The divorce or legal separation of the covered employee from the employee's spouse.
    4. The covered employee becoming entitled to benefits under Medicare.
    5. A dependent child ceasing to be a dependent child under the generally applicable requirements of the plan.
    6. A proceeding in a case under title 11 bankruptcy, commencing on or after July 1, 1986, with respect to the employer from whose employment the covered employee retired at any time. In this case, a loss of coverage includes a substantial elimination of coverage with respect to a qualified beneficiary (spouse/domestic partner, dependent child or surviving spouse /domestic partner) within one year before or after the date of commencement of the proceeding.
    7. Is enrolled in any non-calendar year group health plan or individual health insurance coverage, even if the qualified individual or his or her dependent has the option to renew such coverage. The date of the loss of coverage is the last day of the plan or policy year.
  2. The qualified individual gains a dependent or becomes a dependent through marriage, domestic partnership, birth, adoption, placement for adoption, child support or other court order.
  3. The qualified individual's, or his or her dependent's, enrollment or non-enrollment in a health plan is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, misconduct or inaction of an officer, employee, or agent of the Exchange or HHS, or its instrumentalities as evaluated and determined by the Exchange.
  4. The enrollee or, his or her dependent adequately demonstrates to Health Net that the health plan in which he or she is enrolled substantially violated a material provision of its contract in relation to the enrollee.
  5. The qualified individual or enrollee, or his or her dependent, gains access to a new health plan as a result of a permanent move.
  6. Newly eligible or ineligible for advance payments of the premium tax credit, or change in eligibility for cost-sharing reductions.
  7. He or she loses medically needy coverage under Medicaid (not including voluntary termination or termination due to failure to pay premium).
  8. He or she loses pregnancy-related coverage under Medicaid (not including voluntary termination or termination due to failure to pay premium).
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