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Business Health Insurance

 
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Business Health Insurance

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 Group Health Insurance Quote Short Form
 What industry is your business in?
    
 Please describe the nature of business:
    
 Year or time frame business started:  
 Owners years of experience in the business:  
 Number of Owners and / or Partners:  
 Number of employees that work more than 30 hours a week:  
 Number of employees that work less than 30 hours a week:  
 Number of Sub-Contractors:  
 What is your business legal entity?  
  Step 2 of 3
 If currently insured, what insurance company?   
 If currently insured,  Expiration Date of Policy: 
Medical Plans (select at least one)
(MMP) Major Medical Plan - This plan is favored by those who prefer to choose any doctor or hospital. This is typically the most expensive medical program.
(PPO) Preferred Provider Organization - This plan generally affords you the ability to choose any doctor or hospital from the PPO's directory or to use a doctor outside the plan, at a higher expense.
(POS) Point Of Service - This plan typically has a network, but allows for self and physician referrals to be covered regardless of network status.
(HMO) Health Maintenance Organization - Often the most affordable plan, it strictly regulates access to doctors and hospitals to a specific network.
Optional Coverages/Benefits - (select any that you are interested in)
Dental Coverage - Inexpensive coverage to assist in the cost of cleaning and maintaining teeth.
Maternity Coverage - Covers Maternity under the same benefits as an illness.
Prescription Benefit - Covers Prescription Drugs with a co-payment.
Vision Care Benefit - Covers some costs associated with vision care and correction.
Life Insurance - Provides additional life insurance protection.
Disability Insurance - Provides disability insurance protection, long term and short term available.
401K - A retirement option that is not related to Health Insurance, but often installed at the same time of a health insurance plan or open enrollment.
Other information your agent should know:
 When do you need coverage to start? 
  Finish for Quotes
 Name of Business:
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 First Name:
 Last Name:
 Address:
 City:
Recommended Site for Insurance
 State or Province:
 Zip Code / Postal Code:
 Primary Phone:
 Alternate Phone:
 Fax:
 Email: