Group Health Insurance

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Please indicate the total number of employees, including yourself, who are eligible for this group health insurance plan: [?] This field is required.


(Selecting this answer will redirect you to our Individual Policy partner.)

(Answer with numbers only, -- e.g., 4, not four.)

Please Note: The number you enter should reflect only eligible employees and should not include any spouses or dependents.

Do you currently offer group health insurance coverage? This field is required.


If you do currently offer a group health plan to your employees, what types of coverage are available? This field is required.

(please check all that apply)






What types of health insurance plans are you currently considering? This field is required.

(please check all that apply)





What types of coverage would you like in addition to primary medical? This field is required.

(please check all that apply)






In which state(s) do you have employees residing?
This field is required.

(please list all states - ex. MA, MI, IL)

How many years has your company been in business?
This field is required.

How many eligible employees do you have within each of the following groups? [?] This field is required.

Health plans with higher up-front, employee-paid, deductibles may also include lower premiums and greater flexibility. Do you have a preference for this type of plan? This field is required.



Please Note: States have varying definitions of what constitutes an "employee and spouse" relationship; please refer any questions regarding domestic partner eligibility to the suppliers that respond to your request.

What is the five digit ZIP code for your office location? This field is required.

zip lookup for major cities

What is your e-mail address?[?] This field is required.

Please note any other considerations you would like suppliers to be aware of relating to your group health insurance inquiry:

Note: There is a 1,000 character limit for this answer. (example answers)

We require an email address so our suppliers can contact you to provide price quotes. For more information, please consult our Privacy Policy.

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