Group Health

Please use the form below to contact us.






Contact Information

 
Name
Email
Phone

Tell Us About Your Business

 
Company
Address1
City
State
Zip
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
Any additional information to consider as we process your request?