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Gender
Male
Female
Birthdate
Current Age:
Height
4'10"
4'11"
5'
5'1"
5'2"
5'3"
5'4"
5'5"
5'6"
5'7"
5'8"
5'9"
5'10"
5'11"
6'
6'1"
6'2"
6'3"
6'4"
6'5"
6'6"
6'7"
6'8"
6'9"
6'10"
6'11"
7'
7'1"
7'2"
7'3"
7'4"
7'5"
7'6"
Weight
80-150 lbs
151-200 lbs
201-250 lbs
251-320 lbs
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Household Size
1
2
3
4
5
6
7
8
Expected Annual Income
Below $20,870
$20,871-$58,319
$58,320+
Qualifying Life Event
Got Married
Got Divorced
Loss of Coverage
Moved
Changed or Lost Job
Birth or Adoption
None
Any In The Last 10 Years?
Cancer
Heart Attack
Stroke
Diabetes
AIDS / HIV
Pulmonary Disease
None
Do You Smoke?
Yes
No
Is Anyone Pregnant?
Yes
No
Currently On Medicaid?
Yes
No
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