Thank you for your interest. Quotes are for Minnesota and Western Wisconsin organizations only, and are not final rates (which are subject to underwriting). Use this form to submit a small group medical insurance quote request (2-50 EEs).
Please contact us separately to request a quote for a large group (above 50 EEs) or for products other than medical insurance (i.e. dental, disability, etc.).
If a required field is not applicable please put: n/a
AT THE END OF THIS FORM WE WILL ASK YOU TO FAX UP TO THREE ITEMS IF APPLICABLE:
1) A COPY OF YOUR MOST RECENT GROUP HEALTH INSURANCE INVOICE;
2) CURRENT GROUP PLAN DESCRIPTION;
3) CENSUS SHOWING AGES OF ALL ELIGIBLE EMPLOYEES, THEIR SPOUSES AND DEPENDENTS - (fax; or can fill-in information in the CENSUS section below).
