Group Quote

Check Type Of Coverage:
Health
Medicare Supplement
Medicare Advantage
Long Term Care
Term Life
Whole Life
Vision
Dental
Cancer/Critical Illness

To obtain a quote:
  1. Complete group information below.
  2. Life & Health Options will contact you regarding an employee census.
    Census should include the following information on all full-time employees:
  • Date of birth
  • Gender (Male/Female)
  • Type coverage (EE= Employee only, ES=Employee/Spouse, EC=Employee/Child(ren), F=Family)
  • WOC =waiving due to other coverage
  • W = waiving-no coverage
  • WP = waiting period
  • Questions? Call 225-772-2794, 877-749-8051 toll-free, or e-mail
* As companies look for ways to reduce health insurance costs, many are scaling back their retiree benefit plans and offering Medicare Supplements or Medicare Advantage plans.
 

 
For a Health, Life, Dental, Vision or Cancer/Critical Illness quote, complete items 1-15.
1) Contact Person:
2) Business Name:
3)Street Address:
City, State, Zip:
,,
4) Phone number:
5) Fax:
6) Email:
7) Industry Description/Nature of Business:
8) Total # Full-time Eligible Employees:
9) Total # Covered Employees:
10) Effective Date Requested:
11) Current Carrier/Insurer:
12) Current Office Visit + Hospital Benefit:
13) Current Rates:
14) Renewal Rates, if available:
15) Employer Contribution:
(list amount or percentage)		 Employee:
Dependent(s):
Additional comments or questions:
Best time to contact: