Employer-Sponsored Coverage

Free Quotes and Consults!

We offer quotes for groups and small businesses! To be eligible the group must comprise of two persons who are not related to each other with active payroll! 

Information that is needed: 

Company Name:

Company Tax ID:

Company Address:

Full names of each employee, even those who will not be covered:

What employees will be covered:

Date of birth for each employee opting in for coverage as well:

If family members are to be included, their date of births and full names:

A helpful code for this is: 

 EE = Employee Only
ES = Employee and Spouse
EC = Employee and Children
EF = Employee and Family. 

To receive a free quote please provide the following information to our secure fax or email: or  1-888-638-0614

Please allow up to 48 hours to compile the quote. 

Dock Here!

Please click below for a fillable document