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Employer Group Information - Instant Quote Request Form

Group Employer

Company Information

Required to log back in:

User ID and Password

Email Address (required to login)
A value is required.Invalid format.
Password (between 7 & 22 numbers or letters)
A value is required.

Company NameCompany Name

A value is required.
number of employees Number of individuals enrolling
company zip Zip
A value is required.Invalid format.
sic SIC
your name Your Name
Your Number Phone Number
(Area Code + Number) ie.: (213)555-1212

  Shopping for business insurance is important. We find many that visit our site wish to return and review their proposal or inquire regarding additional insurance information. Therefore, we have created a secure login feature protected by a User ID and Password. Please provide your email address and create a password so you can access your information later. Your email address will be your User ID for signing into the site. We'll also use it to send additional rate, benefit, and underwriting information. Your Password is case sensitive and must be between 7 and 22 numbers or letters.

  Upon entering this section of the website, you "AGREE" with the following terms and conditions: We do not guarantee or warrant the correctness or completeness of the rate and benefit information contained herein and shall not be liable for any loss or damage arising out of use of the quoted rate and benefit information. Additionally, the rate and benefit information contained in this website is limited in scope, subject to change without notice, and does not contain all the terms, conditions, limitations, or exclusions of the referenced benefit plans. Only the Plan Documents contain the exact terms and conditions of coverage. Your grant of access to the rate and benefit summaries contained herein may not be relied upon as a guarantee of your eligibility or coverage under these benefit plans.

  Keep in mind final rates and benefits are based on actual plan selection (including plan riders you may request) and the assignment of any rate adjustment factors due to the health plan's underwriting guidelines.

  Do Not Cancel your current coverage until a new policy is approved and you have received written confirmation of the policy's rates and benefits from the insurance company.