Tax deductions: Did you know that 100% of insurance premiums are a business tax deduction?
A Group Health Plan is a great incentive that can help you hire and retain the best workers. On top of that, there are great tax incentives for businesses that provide health insurance.

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Employee Name Age: Married Y/N:
--Spouses Name Age: # of Children:

Employee Name Age: Married Y/N:
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Employee Name Age: Married Y/N:
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Employee Name Age: Married Y/N:
--Spouses Name Age: # of Children:

Employee Name Age: Married Y/N:
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Small Business
Group Health Insurance

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Insurance Plans
Humana Health Insurance

Blue Cross Insurance

Aetna Health Insurance

Celtic Health Insurance

 

	Select--> NOT LISTED ACCOMODATION AND FOOD SERVICES   Agriculture, Forestry, Fishing and Hunting   Carpet and Upholstery Cleaning Services   Caterers   Drinking Places (Alcoholic Beverages)   Employment Services   Facilities Support Services   Food Services and Drinking Places   Investigation and Security Services   Janitorial Services   Landscaping Services   Limited-Service Restaurants   Office Administrative Services   Other Services to Buildings and Dwellings ARTS, ENTERTAINMENT, AND RECREATION   Amusement, Gambling, and Recreation Industries   Performing Arts, Spectator Sports, and Related Industries CONSTRUCTION   Drywall and Insulation Contractors   Electrical Contractors   Finish Carpentry Contractors   Flooring Contractors   Framing Contractors   Glass and Glazing Contractors   Masonry Contractors   Nonresidential Building Construction   Other Specialty Trade Contractors   Painting and Wall Covering Contractors   Plumbing, Heating, and Air-Conditioning Contractors   Poured Concrete Foundation and Structure Contractors   Residential Building Construction   Roofing Contractors   Siding Contractors   Structural Steel and Precast Concrete Contractors   Tile and Terrazzo Contractors   Utility System Construction EDUCATIONAL SERVICES   Elementary and Secondary Schools   Sports and Recreation Instruction FINANCE AND INSURANCE   Agencies, Brokerages, and Other Insurance Related Activities   Insurance Carriers   Investment Advice HEALTH CARE AND SOCIAL ASSISTANCE   Child Day Care Services   Home Health Care Services   Hospitals   Individual and Family Services   Medical and Diagnostic Laboratories   Nursing and Residential Care Facilities   Offices of Chiropractors   Offices of Dentists   Offices of Mental Health Practitioners (except Physicians)   Offices of Optometrists   Offices of Physical, Occupational Speech Audiologists   Offices of Physicians INFORMATION   Internet Publishing and Broadcasting   Internet Service Providers, Web Search, Data Processing Services   Software Publishers   Telecommunications MANAGEMENT OF COMPANIES AND ENTERPRISES   Corporate, Subsidiary, and Regional Managing Offices MANUFACTURING   Fabricated Metal Product Manufacturing OTHER SERVICES   Automotive Repair and Maintenance   Beauty Salons   Business, Professional, Labor, Political, and Similar Organizations   Car Washes   Civic and Social Organizations   Commercial/Industrial Machinery Equip Repair/Maint (not auto/elect)   Diet and Weight Reducing Centers   Electronic and Precision Equipment Repair and Maintenance   Home and Garden Equipment and Appliance Repair and Maintenance   Other Personal and Household Goods Repair and Maintenance   Parking Lots and Garages   Pet Care (except Veterinary) Services   Private Households   Religious Organizations   Social Advocacy Organizations PROFESSIONAL, SCIENTIFIC AND TECHNICAL SERVICES   Accounting, Tax Preparation, Bookkeeping, and Payroll Services   Administrative Management Professional Management Consulting   Advertising and Related Services   Architectural Services   Building Inspection Services   Computer Systems Design and Related Services   Engineering Services   Environmental Consulting Services   Human Resources and Executive Search Consulting Services   Landscape Architectural Services   Legal Services   Marketing Consulting Services   Other Management Consulting Services   Other Scientific and Technical Consulting Services   Other Specialized Design Services   Photographic Services   Scientific Research and Development Services REAL ESTATE AND RENTAL AND LEASING   Lessors of Residential Buildings and Dwellings   Offices of Real Estate Agents and Brokers   Offices of Real Estate Appraisers   Real Estate Property Managers RETAIL TRADE   All Other Professional Merchandise Stores   All Other Miscellaneous Store Retailers   All Other Specialty Food Stores   Automobile Dealers   Automotive Parts, Accessories, and Tire Stores   Clothing Stores   Cosmetics, Beauty Supplies, and Perfume Stores   Gift, Novelty, and Souvenir Stores   Nonstore Retailers   Sporting Goods Stores TRANSPORTATION AND WAREHOUSING   All Other Support Activities for Transportation   Couriers and Messengers   Professional Freight Trucking, Local   Professional Freight Trucking, Long-Distance   Limousine Service   Motor Vehicle Towing   Other Support Activities for Transportation   Other Transit and Ground Passenger Transportation   Taxi Service UTILITIES   Utilities WASTE MANAGEMENT AND REMEDIATION SERVICES   Waste Management and Remediation Services WHOLESALE TRADE   Apparel, Piece Goods, and Notions Merchant Wholesalers   Wholesale Trade Agents and Brokers OTHER
What type of industry is the business in?
What is the nature of the business?
	Select--> Just Starting Now Seasonal_Event One Time Event 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 or Earlier
Time frame or year business started:
Owners and / or Partners:	Select--> less than 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 21+
How many full-time employees:	Select--> 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21+
How many part-time employees:	Select--> 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21+
How many sub-contractors:	Select--> 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21+
Type of Business legal entity?	Select--> Corporation S Corporation Limited Liability Company Limited Liability Partnership Partnership Sole Proprietorship Limited Partnership Professional Corporation Nonprofit Corporation Other
Amount of liability coverage needed: (Approx.)	Select--> None or Dont Know Not Applicable Less than $1,000,000 $1,000,000 to $1,999,999 $2,000,000 to $2,999,999 $3,000,000 to $3,999,999 $4,000,000 to $4,999,999 $5,000,000+
If currently insured, current insurance company:	Not Insured AAA Insurance Co. AETNA AFLAC AIG AIU Insurance Allied Allstate County Mutual Allstate Indemnity Allstate Insurance American Alliance Insurance American Automobile Insurance American Casualty American Deposit Insurance American Direct Business Insurance American Empire Insurance American Family Insurance American Family Mutual American Financial American Home Assurance American Insurance American International Ins American International Pacific American International South American Manufacturers American Mayflower Insurance American Motorists Insurance American National Insurance American Premier Insurance American Protection Insurance American Republic American Savers Plan American Service Insurance American Skyline Insurance Company American Spirit Insurance American Standard Insurance - OH American Standard Insurance - WI Amica Insurance Arbella Associated Indemnity Assurant Atlanta Casualty Atlantic Indemnity Auto Club Insurance Company Blue Cross and Blue Shield Cal Farm Insurance California State Automobile Association Chubb Clarendon American Insurance Clarendon National Insurance CNA Colonial Insurance Company Not Listed Continental Casualty Continental Divide Insurance Continental Insurance Cotton States Insurance Country Insurance and Financial Services Dairyland County Mutual Co of TX Dairyland Insurance Electric Insurance Erie Insurance Company Erie Insurance Exchange Erie Insurance Group Erie Insurance Property and Casualty Esurance Farm Bureau/Farm Family/Rural Farmers Insurance Farmers Insurance Exchange Farmers TX County Mutual Farmers Union Fire and Casualty Insurance Co of CT Fireman's Fund Geico Casualty Geico Professional Insurance Geico Indemnity GMAC Insurance Golden Rule Insurance Government Employees Insurance Guaranty National Insurance Hanover Lloyd's Insurance Company Hartford Accident and Indemnity Hartford Casualty Insurance Hartford Fire Insurance Hartford Insurance Co of Illinois Hartford Insurance Co of the Southeast Hartford Omni Hartford Underwriters Insurance Health Plus of America HealthShare American IFA Auto Insurance IGF Insurance Infinity Insurance Infinity National Insurance Infinity Select Insurance Integon John Hancock Kaiser Permanente Kemper Lloyds Insurance Landmark American Insurance Leader National Insurance Leader Preferred Insurance Leader Specialty Insurance Liberty Insurance Corp Liberty Mutual Fire Insurance Liberty Mutual Insurance Liberty National Liberty Northwest Insurance Lumbermens Mutual Mass Mutual Mega/Midwest Mercury Metropolitan Insurance Co. Mid Century Insurance Mid-Continent Casualty Middlesex Insurance Midland National Life Mutual of New York Mutual Of Omaha National Ben Franklin Insurance National Casualty National Continental Insurance National Fire Insurance Company of Hartford National Health Insurance National Indemnity National Union Fire Insurance of LA National Union Fire Insurance of PA Nationwide Professional Insurance Nationwide Mutual Fire Insurance Nationwide Mutual Insurance Nationwide Property and Casualty New York Life Insurance Northwestern Mutual Life Northwestern Pacific Indemnity Omni Indemnity Omni Insurance Orion Insurance Pacific Indemnity Pacific Insurance Pafco Professional Insurance Patriot Professional Insurance Peak Property and Casualty Insurance PEMCO Insurance Progressive Progressive Auto Pro Prudential Insurance Co. Reliance Insurance Reliance National Indemnity Reliance National Insurance Republic Indemnity Response Insurance SAFECO Safeway Insurance Safeway Insurance Co of AL Safeway Insurance Co of GA Safeway Insurance Co of LA Security Insurance Co of Hartford Security National Insurance Co of FL Sentinel Insurance Sentry Insurance a Mutual Company Sentry Insurance Group Shelter Insurance Co. St. Paul St. Paul Fire and Marine St. Paul Insurance Standard Fire Insurance Company State and County Mutual Fire Insurance State Farm County State Farm Fire and Cas State Farm Professional State Farm Indemnity State Farm Insurance Co. State Farm Lloyds Tx State Farm Mutual Auto State National Insurance Superior American Insurance Superior Guaranty Insurance Superior Insurance The Ahbe Group TICO Insurance TIG Countrywide Insurance Travelers Indemnity Travelers Insurance Company Tri-State Consumer Insurance Twin City Fire Insurance UniCare United Pacific Insurance United Security United Services Automobile Association Unitrin Direct US Financial USAA USF and G Viking County Mutual Insurance Viking Insurance Co of WI Windsor Insurance Woodlands Financial Group Company Not Listed
If currently insured, expiration date:
If currently insured, annual premium range:	Select--> Not Insured Insured, but I dont know. $500 - 999 $1,000 - 2,999 $3,000 - 4,999 $5,000 - 9,999 $10,000 - 19,999 $20,000 - 49,999 $50,000+

	Medical Plans to Quote - (select at least one)
		(MMP) Major Medical Plan - A plan is favored by those who prefer to choose any hospital or doctor. This is usually the most expensive medical plan.
		(PPO) Preferred Provider Organization - A plan that generally allows you the ability to choose any hospital or doctor from the PPO's directory or to use a doctor outside the plan, at a higher cost.
		(POS) Point Of Service - A plan that typically has a network, but allows for self and physician referrals to be covered regardless of network status.
		(HMO) Health Maintenance Organization - Often the most affordable plan, it strictly regulates access to doctors and hospitals to a specific network.
	Optional Coverages/Benefits - (select any that you are interested in)
		Dental Coverage - Inexpensive coverage to assist in the cost of cleaning and maintaining teeth.
		Maternity Coverage - Pays Maternity under the same benefits as an illness.
		Prescription Benefit - Pays for Prescription Drugs with a co-payment.
		Vision Care Benefit - Covers some costs associated with vision care and correction.
		Life Insurance - Additional life insurance protection.
		Disability Insurance - Disability insurance protection, long term and short term available.
		401K - Retirement option that is not related to Health Insurance, yet often installed at the same time of a health insurance plan or open enrollment.

When do you need coverage to start?

Select--> By Renewal Date ASAP 1 Week 2 Weeks 3 Weeks 1 Month 2 Months 3 Months Longer than 2 Months Not Sure

Last Step: Finish for Quotes.  Your information is kept safe and secure and will only be used to provide you with quotes.
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