FREE  ON-LINE  Small Business
Group Health Insurance Quote Form
(For RI, MA, CT small businesses  only)

    Company Name: Street Address:
     City,State   Zip code:
    SIC code if known:  Company Phone:  
    Your Name:

      CEO/President/  Principal/Partners/Owner(s) if under 20 employees  or Controller  for 20+)  
      (Required)        
      Email address(es)  of the above (Required)
      
 
IMPORTANT:Quotes and unique customized savings strategies take hours of preparation. We've saved groups as much as $6000 per employee per year in health insurance premium savings while showing the employer how the group can obtain the same or better  protection while enabling them to keep most of their tremendous savings! We don't want to waste your time or ours! Please make sure our terms are acceptable specified in our brochure  listed under "The Process". Link to the brochure here.

Choose one: We are curious about options and still shopping around We will be making a change within 60 days We are curious about Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAa) We want to install a group HSA plan as soon as possible. We'd like a traditional plan with low co-pays for ER office vists and Rx. Plan design is more important than cost. We'd like to try to keep a traditional plan design with co-pays  for office visits etc but cost savings is a priority. We want guidance to direct us to the best possible protection for the least overall cost We want 100% protection after a deductible. Co-pay plans are a rip off.

Choose One:   Full access to all care nationwide w/o restrictions;& worldwide while traveling that is affordable is a priority All we want is lower office vist co-pays. We'll risk not being covered at all outside a small network.
Please Provide the Following Required Info: Employer contribution %-: (Must be  at least 50% of  employee's cost not including dependents.)    Current  group Monthly Premium- :   Individual Rate/Month  Family Rate/Month  Other ie employee+children or employee+spouse  rates if applicable Anniversary Date:Exact name of current plan, carrier name  and type  (ie HMO, POS, PPO) -:      

   Before we provide our census info, we have a few questions. Please call us at your earliest convenience.
                       
                                       Census Information - required to calculate rates
                          Employee/Name (optional)       Sex        Age     Spouse        How many
                                                                                           (M,F)                       (Age)             children?

             Thanks for your request. Don't forget to click "submit" at the top of the page.   We'll be contacting you  about your requested rate information soon. For larger groups, download a census form at the top of this page that you can fax in to us .E-mail Emily at emilyh@healthplanspecialists.com  with any questions or call 401-848-7708.