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Get a Group Quote

    Group Information

    Group Name (required*)
    Contact Name (required*)
    Contact Email (required*)
    Phone Number
    Requested Effective Date
    Zip (required*)
    Nature of Business (required*)
    SIC Code
    Current Carrier
    Any 1099 Employees?

    Quotes Specifications

    Would you like age banded rates or Composite rates?
    Please tell us the minimum amount of hours your employees can work to qualify for health insurance:
    Employer contribution for employee & dependents (required* - Can be a percentage, minimum of 50% of the lowest priced plan your company offers or a dollar amount equal to that affect):

    EE Dep

    Please check all products to be included in your quote.

    All Products Listed BelowInclude AD&D/LTD/STD

    Anthem Blue Cross Blue Shield

    MedicalDentalAncillary

    Cigna self-funded (20 or more lives )

    MedicalDentalAncillary

    Delta Dental

    MedicalDentalAncillary

    MetLife

    MedicalDentalAncillary

    Rocky Mountain Health Plans

    MedicalDentalAncillary

    UnitedHealthcare

    MedicalDentalAncillary

    Vision Service Plan (VSP)

    Vision Insurance

    Census

    Please provide the following information for each employee:

    • Relationship (Employee, Spouse/Partner or Child/Dependent)

    • First Name, Last Name

    • Age, Date of Birth

    • Gender

    • Tobacco Use (Required for Medical Only)

    • Zip Code

    Please list all Spouse/Partner and Child/Dependent information directly below the Employee's with whom they are associated.