It’s as Easy as 1,2,3!

1. Fill out the Employee Data Form below

2. Be sure to upload any Extended Health Care and Dental claims experience (for the past 3 years) that you should have, along with a copy of your current group insurance invoice (upload as attachment at bottom of form) 

3. Once you have submitted your form, we will then determine the appropriate insurance company for your plan and prepare a proposal. If we have any questions, we will contact you.

Or, contact us at, or by phone at 800.265.2178!

We look forward to hearing from you.

Get a Quote

Fill out our online form below or download and print our pdf form