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Florida Health Insurance Plus: Group Health Insurance Quote Request

Please take a moment to fill out the form below and one of our representatives will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.

 

Legal Name of Business
Contact Name
Address
City
State
Zip
Business Phone
Best Time to Call
am
pm
Email
Type of Business
No of Full time employees
part time
Current Carrier
Policy Expiration Date
Premium Amount?
Brief Description of Current Coverage
Medical Deductible
Dental?
Yes
No
Vision?
Yes
No
Short Term Disability
No
Yes
Yes
No
Group Life
Yes
No
On/Off the Job Accident
Cancer
No
Yes
Yes
No
Critical Illness
PPO / HMO
Hospitalization
No
Yes
Yes
No
Intensive Care
Please list all employees that you wish to cover
Gender
DOB
Zip
Coverage Type
If there are additional employees to be listed please enter information in box below or fax to 850-934-7992
Please click the submit button to request your quote for group health coverage. This is for quoting purposes only. Never cancel existing coverage until new coverage is signed for and effective. Thank you.
Type of Business
Current Coverage
Benefits Desired
Employee Information
Additional Employees, Comments or Questions

Personal Insurance Quotes

Group Insurance Quotes

 

 

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Licensed in Florida L003722
Alabama A272605
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