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Group Health Insurance Quote
Group Health Insurance Quote
If you already have an application filled out or you have your employees’ information stored on a document please email it to us at
[email protected]
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Contact person
Email
*
Phone Number
How is the business held?
Sole Proprietorship, Corporation, LLC . . . etc.
Business legal name
Business address
Total number of full time employees (30 plus hours per week)
Who will you offer insurance to?
Employees, spouses, dependents . . . etc
Does your business currently offer health insurance? Which carrier?
Please provide eligible employee information and dependent information (if offering dependent coverage)
Full name, date of birth, social security number or tax ID number, home address
Employer's contribution towards employees' premium
50%, 75%, 100% . . etc
Employer's contribution towards employees' premium
0%, 25%, 50% . . . etc
Additional pertinent info
Are there particular carriers you want to be included in your quote? Are you looking to offer a lot of options to your employees or would you prefer to offer just the lower-cost options? When does your current policy renew?
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