Online Quotes

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Assurant Health Assurant Short Term Medical

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Case Submission Packet
Agent Appointment
  Elite Full Vision-Only Plan A*
Elite Full Vision-Only Plan B
Vision (materials only) w/hearing A*
Vision (materials only) w/hearing B
Dental (2-9)

* Plan A: Frames every 12 mos.
Plan B: Frames every 24 mos.

  Secure Med STM
Secure 12x3 STM
Secure DentalOne
Overseas Travel Medical
The Competitor Rx-Pay Card

The Competitor Smile Dental

  Securian Dental
Rate Calculator (2-99)

  The Avesis Network of Vision Providers
Fully-insured vision plans  |  Sales Flyer

  Community Eye Care
CEC Vision Plan

  Specialty Risk International
International and Travel Medical Insurance

Request a Quote

Group Quotes / Other Insurance Quotes

Email us:
Preferred format: Microsoft Excel
or use the Online Request Form, below:
(*=required, ✓=recommended)

 

Case Name: *
Case Location (ZIP): *
Nature of business: *
Case SIC code:

Broker Name: *
Mailing Address:
Address Line 2:
City, State, Zip:
Telephone: *
FAX:
E-Mail:

If group quote is requested, please continue, to enter census.
For other (non-group) quotes, please skip to Comments field below

Online Census Form

Fill out the table below with your employee census information.
You can enter up to 30 entries at a time.

Click here for detailed instructions

EE#:  1-30  31-60   61-90   91-120  121-150

EE# Sex (M/F) Smoker?
(S/N)
Employee
Age
YOB
Amount
Life
Salary
Spouse
Age
YOB
Smoker?
(S/N)
# Children
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

Enter your comments below (for example, tell us about known health problems in the group.)

Form updated Wednesday, July 23, 2008 10:50 AM