Note for service fee: according the ACA law, our services for people to get ACA (Obamacare) tax credit must be free. If you apply for Short-Term Health Insurance, our services are also free. However, the insurance company may require $20 fee to process your application and finalize their insurance paper works. Also, we are hiring: see details.

Short-Term Insurance Fact Find

- Input your data in each box below, one by one, and then click Submit Fact Find at bottom.
Don't hit Enter-key, use mouse/Tab-key move to next. Input can't be saved, must submit; or, you do it again.



Health Insurance Fact Find
- By submit this form, you choose Henry Hu as your exclusive agent to
buy health insurance
  and to apply for financial aid - ACA Tax Credit.

  Note:  If applying for Travel Medical Insurance (to visit USA), please provide your current home address and phone # of your country, and send (email) us a copy of your passport page that has your name and picture. If you have a contact person or a mailing address in the US, please provide that address, name, phone, and email address. You may download the application, complete, sign, and dated, and then email it to us. All using English.

Tips: for Travel Medical Insurance, it is NOT required to check health data (as listed below). For normal short-term insurance, each applicant must report any illnesses as listed. However, we do not recommend, for lower premium, to report minor ones.

Home address     ( 家庭住址,    Dirección de la casa )

Phone number      ( 電話號碼,    número de teléfono ) 

Email address     ( 電子郵件,    Email Dirección )  


Birthday (mm-dd-yyyy)


Gender (M/F)

US Citizen Greencard passport

Have serious illness (Yes/No)

 Height (foot . inch)

Weight (pound, lb.)













EE.UU. / tarjeta verde

Yes / No




   Note: if have serious illness, provide person’s name and name of the illness. Also, please list smoker's name if not indicated.
   After finished, click Submit (at bottom) to send. We will email you a quote within 24 hours and maybe call you for the quote.

Tips: Use your cell phone to take pictures of documents and email the pictures to us: Also, for your data safety (not to send online), you may use your cell phone to take a 'screen shot', after filled in all your family data, and then email the picture to us.

Agreement: I am (print name). I agree to provide my family personal data (birthday, weight, height, health, etc.) for Henry Hu Agency to assist me to apply for health insurance. I know all short-term plans are different from the ACA (Obamacare) plans and I agree to take responsibility for data I provided. Henry Hu Agency will keep the data confidential for applying insurance only and protect privacy of all applicants.

Get Confirmation:  In order to make sure that we have received your application (the Fact Find) after you click the button “Submit Fact Find”, please call our cell phone (503) 475-4705 to get a confirmation number. Thanks for your cooperation.