Quote

You need the free Flash player plugin to watch this movie. Download it now.

 

Group Health

Thank you for your interest.

There are certain types of benefits that employees will automatically expect from their employer. The first is health care. The majority of employees will not only expect you to provide these benefits, but may also be interested in other options, including group life and group dental.

After completing the form, please click on the "Submit" button. Your information will be emailed to our offices and we will process your request. All information will be kept confidential.

Contact Information

Name:  
Phone:  
Email Address:  


Tell Us About Your Business


Company Name:  
Address:  
City:  
State:  
Zip Code:  
Please describe the type of business
you operate: 		 
When would you plan on implementing your new health-care plan?   During the next month
Within three months
Before the end of the year

How many employees would be eligible for the new health-care plan?  

What percentage of eligible employees would you expect to participate?  

Policy Information

What co-payment amount would you like your employees to spend when visiting a doctor's office?   $10
$15
$20
more than $20
none

Would you like your employees to have a prescription co-payment card?   Yes   No  

What type of plan would best fit the needs of your employees?  

What amount of hospital deductible is best for your policy?  

What amount of coinsurance is best for your policy?  

Do you want to offer group life insurance?   Yes   No  

Do you want to offer group dental?   Yes   No  

Is there any additonal information you would like us to consider as we process your request?  

These quotes do not guarantee coverage and
actual premiums may differ from the quotes provided

Please type the words you see below into the yellow box. This helps keep our form secure and prevent spam.