Individual & Family kit request form

Request information

Prevea360 Health Plan offers individual and family health insurance plans to fit your lifestyle and budget. Whether you’re looking for a lower-premium plan, to limit your overall out-of-pocket costs, or for a catastrophic safety net plan, we’re here for you.

We offer individual & family plans to residents of Brown, Chippewa, Door, Eau Claire, Kewaunee, Manitowoc, Oconto and Sheboygan counties.

Our plan kit walks you through your options with each type of plan, as well as your enrollment options through the Marketplace or directly with Prevea360 Health Plan. To receive an individual and family plan kit in the mail to explore your options, please fill out and submit the form:

First Name*

Last Name*

Phone number*

Email*

Address 1*

Address 2

City*

State*

ZIP code*

In what county does the prospective applicant live?*

How did you hear about Prevea360 Health?

I consent to receive marketing communications via email and mail from Prevea360 Health Plan. I am aware that I may opt out via unsubscribing from emails or calling Customer Care to be removed from the mailing list.

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