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    Carlson & Carlson Inc.

    15 Wilmot Lane

    Riverside, CT 06878

    Phone: (203) 637-7575

    Website: https://carlsonandcarlson.com/

    Email: jsteiner@carlsonandcarlson.com

USAway Major Medical Application

International Health Insurance

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THIS IS NOT QUALIFYING HEALTH COVERAGE ("MINIMUM ESSENTIAL COVERAGE") THAT SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU DON'T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES.

This plan does not cover pre-existing conditions.

This plan does not cover preventative care.

Coverage cannot be purchased in the following states:  GU, MD, NM, NY, SD

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