Group Quote


Please enter your information below and click "Submit".







































The contact information allows us to better understand the type of group health plan that’s in place. To obtain final rates we will be contacting you requesting the following information depending on your group size:

Under 50 eligible employees:

  • Employee Census with date of birth, zip code, gender, tobacco use and election status (EE, EE/Spouse, EE/Child, Family)

Over 50 eligible employees:

  • Employee Census including date of birth, gender, election status
  • Claims history – last two years total claims data
  • Large claims report – last two years of large claims (any claim over $10,000) including diagnosis/prognosis and current status (active/cobra/cancelled)
  • Copies of current benefit summaries or SBC
  • If self-funded include specific and aggregate reports