Proposals & Quotes

Business Name

Company Address

City

State

Postal code

Company Phone

Tax ID

Contact Person

Title

Email

Direct Phone *

Effective Date *

Please provide any benefit specifics being requested along with cost share

Medical

Quote vs Current

New Quote

Medical New Quote

Vision

Quote vs Current

New Quote

Vision New Quote

Dental

Quote vs Current

New Quote

Dental New Quote

STD

Quote vs Current

New Quote

STD New Quote

LTD

Quote vs Current

New Quote

LTD New Quote

Basic Life

Quote vs Current

New Quote

Basic Life New Quote

Accident

Quote vs Current

New Quote

Accident New Quote

Cancer (stand-alone)

Quote vs Current

New Quote

Cancer (stand-alone) New Quote

Critical Illness (stand-alone)

Quote vs Current

New Quote

Critical Illness (stand-alone) New Quote

Cancer/Critical Illness (combined)

Quote vs Current

New Quote

Cancer/Critical Illness (combined) New Quote

Personal Term Life

Quote vs Current

New Quote

Personal Term Life New Quote

Personal Whole Life

Quote vs Current

New Quote

Personal Whole Life New Quote

Hospital Indemnity

Quote vs Current

New Quote

Hospital Indemnity New Quote

GAP

Quote vs Current

New Quote

GAP New Quote

PET

Quote vs Current

New Quote

PET New Quote

Requirements for Proposals/Quotes

EE Census: DOB, DOH, Gender, Occupation Salary

Copy of Current Plan Designs, rates and bills

100 plus EE's - Claim Enperience on Dental, Vision and DI

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