Individual Quote

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If you are an employer with 2-50 or 2-500 employees and want to offer benefits as an incentive to retain your employees, you will be pleased to know that we have many carriers and many plans that can be customized to fit your needs.

Whether you want to provide coverage to different classes of employees or you want to elect a section 125 plan. We can even include worker's compensation with your coverage which will bring your costs down for both medical and workers comp.

To receive a group benefits proposal, please provide us with the information requested below. To obtain the most accurate quote, please be complete when entering in your employee information in the census below. Please include the employee's gender, date of birth, age and family members to be included. Rest assured, all information is confidential. We will respond to your request within 48 hours.

Company Name:
Contact Name:
Title:
Type of Business:
What is your business address?: (Do not use a P.O. Box please)
Street Address:
City:
State:
Zip Code:
E-mail Address:
Business Phone:
Fax:
Web Address:

# of Full Time Employees:
# of Part Time Employees:
Plan Design:		Medical PPO HMO POS Dental PPO HMO Life Vision Disability
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