Phone:
832.612.0472
Email:
info@lifefoundationhomecare.com
Hours of Operation:
Monday-Friday 9:00am to 5:00pm
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Menu
Services
Elder Care
Child Care
Veterans Home Care
Care Model
About Us
Contact Us
Our Caregivers
Areas We Cover
Insurances Accepted
Schedule a FREE Home Care Assessment
Become A Caregiver
Book an Appointment
Services
Elder Care
Child Care
Veterans Home Care
Care Model
About Us
Contact Us
Our Caregivers
Areas We Cover
Insurances Accepted
Schedule a FREE Home Care Assessment
Become A Caregiver
Menu
Services
Elder Care
Child Care
Veterans Home Care
Care Model
About Us
Contact Us
Our Caregivers
Areas We Cover
Insurances Accepted
Schedule a FREE Home Care Assessment
Become A Caregiver
Menu
Services
Elder Care
Child Care
Veterans Home Care
Care Model
About Us
Contact Us
Our Caregivers
Areas We Cover
Insurances Accepted
Schedule a FREE Home Care Assessment
Become A Caregiver
Health Insurance Questionnaire
Insurance Feasibility Questionnaire
We are exploring the feasibility of offering group health insurance for our eligible employees. In order to perform the feasibility, we need to know who is interested in taking health insurance if offered through work. Your answers below will help us assess the need. Thank you for your help
Name
(Required)
First
Last
If offered, would you be interested in getting health insurance under Life Foundation Home Care group health insurance plan?
(Required)
Yes
No
Could you help us by telling us why you are not interested in health insurance? Select all that apply
I already have insurance
I can’t afford it
Don’t wish to answer
Do you have dependents that you would include on your plan?
Yes
No
Please provide Dependent Information. Please include all of them, click on + to add more dependents. Only spouse or eligible children can be covered
Relationship (Spouse/Child)
First Name
Last Name
Date of Birth
Sex (M/F)
Add
Remove
Terms of Use
(Required)
I understand that this is not an offer or acceptance of insurance. If insurance is offered and if you are eligible, you will have an opportunity to confirm enrollment at that time
Signature
(Required)
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