Work Less. Earn More.

Participate in USH&C's Health Insurance Referral Program

Agent

 Agent Name 
 Address 
 Phone Number 
 Email 

Customer

 Customer Name 
 Home Phone Number 
 Mobile Phone Number 
 Best Time to CallTip: Type 'A' or 'P' to switch AM/PM 
 Customer Address 
 Customer Email 

* The customer is looking for the below plan and has been told to expect a call from a USH&C call center agent:



Notes/Plan Recommendations - Do Not Include any medical conditions