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
Telephone
E-Mail
Tell us about your business
Company Name
Address
City
State
Zip Code
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?
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
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