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Group Health

Thank you for your interest.

There are certain types of benefits that employees will automatically expect from their employer. The first is health care. The majority of employees will not only expect you to provide these benefits, but may also be interested in other options, including group life and group dental.

After completing the form, please click on the "Submit" button. Your information will be emailed to our offices and we will process your request. All information will be kept confidential.

Contact Information

Name:*
Phone:*
Email:*

Tell Us About Your Business

Company Name:*
Address:*
City:*
State:*	Zip:*

Please describe the type of business you operate:
When would you plan on implementing your new health-care plan?	During the next month Within three months Before the end of the year
How many employees would be eligible for the new health-care plan?
What percentage of eligible employees would you expect to participate?

Policy Information

What co-payment amount would you like your employees to spend when visiting a doctor's office?	$10 $15 $20 more than $20 none
Would you like your employees to have a prescription co-payment card?	Yes No
What type of plan would best fit the needs of your employees?
What amount of hospital deductible is best for your policy?
Do you want to offer group life insurance?	Yes No
Do you want to offer group dental?	Yes No
Is there any additonal information you would like us to consider as we process your request?

In order to obtain quotes, White Group Benefits, Inc. will need additional information about your employees who are eligible for coverage and their dependents. Attached, for your convenience, is a census form which can be emailed or faxed to us. Our contact information is below. If you have questions about how to fill out the census form or any other questions, please call us at 614-764-3645.
Download Census Form

These quotes do not guarantee coverage and actual premiums may differ from the quotes provided.

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