Group Insurance California -free health insurance quotes


Group Health Insurance Quotes

1) Please indicate the total number of employees, including yourself, who are eligible for this group health insurance plan: [required]

2 or more - Please indicate the exact number:
    (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

*First Name:
*Last Name:
*City Zip
* Phone: Ext.:
* Fax: Ext.:
2) Do you currently offer group health insurance coverage? [required]
Yes - Please provide the health plan & expiration date:
3) If you do currently offer a group health plan to your employees, what types of coverage are available?
(please check all that apply)
    None currently
POS (Point of Service)
Other or not sure
4) What types of health insurance plans are you currently considering? [required]
(please check all that apply)
    Not sure - please help me to determine the best plan for our needs
HMO - managed care system with fairly strict in-network regulations
PPO - more flexible system; permits out-of-network visits with higher co-pay or deductible
POS - most flexible managed care system; open access to providers with plan covering a lower percentage of costs from out-of-network providers
Self-insured - employees deposit premiums into company health insurance fund
5) What types of coverage would you like in addition to primary medical? [required]
(please check all that apply)
    Dental insurance
Wellness programs - discounts to fitness clubs, massage therapy, etc.
Prescription drug plan - comes standard with most plans
Vision/eyewear plan - comes standard with most plans
Not sure
6) In which state(s) do you have employees residing? [required]
(please list all states - ex. MA, MI, IL)
7) How many years has your company been in business? [required]
8) How many eligible employees do you have within each of the following groups? [required]


 Single employee(s)
 Married/legally cohabitating - employee plus spouse, no children*
 Single employee(s) with one or more children - employee plus dependents; no spouse
 Employee(s) with families - spouse and one or more children*
*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.
9) What is the five digit ZIP code for your office location? [required]
NOTE: We only serve U.S. businesses at this time.
10) 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?
    Not sure - please help me select the plan that best meets my needs
Yes - we would prefer a plan with higher deductibles
No - we would like to offer a plan with lower deductibles
   (may result in higher premiums or co-insurance cost for employees)
11) Census: If 10 or fewer employees will be enrolled in the small business health insurance plan, please complete the following census for each employee, indicating sex, age, type of coverage needed and the employee's home zip code.

Please note: If you have greater than 10 employees, the vendor will be contacting you for the census information.

Sex Age Coverage Home Zip Code
12) Please note any other considerations you would like suppliers to be aware of relating to your group health insurance inquiry:

Note: There is a 2,000 character limit for this answer.

You're almost done! If you have answered all of the required questions above, click the "Get Group Health Insurance Quotes" button below to finish and send your request.


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Copyright © 2005 Oleg Skurskiy Authorized Independent Agent, CA License 0E50389