Learn More

To learn more call:
1-800-539-9370
or fill out form under Learn More.

Learn more about how you can receive better health insurance coverage by filling out the form below. To obtain a Health Insurance Quote, copy of Benefit Summaries, and Application Packet, please complete the following:
Company Name:
First Name:	*
Last Name:	*
House No. or Rte.	*
Street or Road	*
City:	*
State:	*
ZIP Code:
Phone:
Email:	*
If applying for as an Individual, 2-Person, or Family please answer the following:
Coverage Status:
Name of Applicant if different than above and name of spouse if there is a spouse:
Applicant:
Spouse:
Date of Birth of Applicant and Date of Birth of spouse if applicable:
Applicant:
Spouse:
Gender of Applicant (only required if applying for Individual coverage):

ZIP Code of business operation if different than above:

Type of Business:
If you belong to a cooperative, please let us know which one:

We will email you your Rate Quote, Benefit Summaries and Application Packet. If you would also like us to contact you by phone, please let us know the best time to reach you.

If applying as a business with 2 or more Full Time Employees
Please download the Employee Census Form on this page, complete it and either: FAX attention "administrators" to us at (570) 265-7758 OR; Mail it attention "administrators" to us at: ASA PO Box 228 Athens, PA 18810
Once we receive the census, a representative will be in touch with you within three (3) business days.
	or
Fields with a * are required.

Farmers Health Cooperative of Wisconsin is a Co-op Care initiative brought to you by the Wisconsin Federation of Cooperatives. FHCW health insurance plans will be managed by Agri-Services Agency which offers coverage through Aetna, one of the nation's top five insurance companies. We are grateful for support from the UW School of Medicine and Public Health’s Partnership Fund for a Healthy Future; AgStar Financial Services; USDA Rural Development; and the Wisconsin Department of Agriculture, Trade and Consumer Protection.