Request an Individual / Family HSA Insurance Quote Please give information ONLY on persons who are to be included in the quote. Form has a TAB sequence set for your convenience. If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Primary Insured First Name * Last Name * Zip Code * Email * Phone * Birth Date * Sex * Male Female Tobacco Use Yes No Spouse Information Spouse Sex Male Female Spouse Birth Date Spouse Tobacco Use Please select Yes No Children Information Child 1 Sex Male Female Child 1 Birth Date Child 2 Sex Male Female Child 2 Birth Date Child 3 Sex Male Female Child 3 Birth Date Child 4 Sex Male Female Child 4 Birth Date Child 5 Sex Male Female Child 5 Birth Date To determine if you qualify for a federal subsidy, will your "2017 household, adjusted gross income" be"? Please select Household size of 1: $11,880-$47,080 Household size of 2: $16,020-$63,720 Household size of 3: $20,160-$80,360 Household size of 4: $24,300-$97,000 Household size of 5: $28,440-$113,640 Household size of 6: $32,580-$130,280 -OR- Based on Household Size, my income exceeds these levels. From Our Blog What are my choices during the 2018 season of health insurance open enrollment with in Houston? Open Enrollment Guide for Individual Health Insurance in Houston What is the current state of the Affordable Care Act with regard to individual health insurance? What are the differences between small group health insurance and individual health insurance? “I hate my Texas health insurance policy” and other topics of recently received emails.