Massachusetts health insuranceMassachusetts group health insurance application

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Massachusetts health insurance

  Group Health Quote

  Group Dental Quote

  Mini-Med Plans

  Medical Gap Plans

  Chamber and Association
  Plans

  Voluntary Work Site
  Benefits from Aflac:

   -Short Term Disability

   -Accident Indemnity

   -Life Insurance

   -Cancer/Disease

   -Critical Illness

   -Hospitalization Plans

   -Dental Insurance

   -Vision Insurance

MA life insurance


  Group Plans:

   -Group Life

   -Group Disability

   -Group Long Term Care

  Individual Plans:

   -Term Life

   -Whole Life

   -Universal Life

   -Disability

   -Long Term Care

Other Ma insurance

  Discount Plans:

   Dental & Vision
    (Click for additional
     discount information)

  Agency Services:

  On-Line Service Request

  Customer Service E-Mail

  
Fast, Friendly, and Professional Service.
SERVING EASTERN & CENTRAL MASSACHUSETTS - OUR SERVICE SETS US APART!

Online Longterm Group Health Insurance Quotation Form
One Simple Form - takes only 2-3 Minutes!
Your Personal/Group Data:
 
Your Name:
Your Business Name:
Street Address:
City:
State: State: MUST be Massachusetts!
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Group Details
(If more than 10 in group, contact us at: 508-479-2700 )

Please Check the Group Products your company wants
to make available to your employees:
Group Health   Group Dental   Group Vision
Group Life   Employee Benefits
Underwriting Information:
 
List employees' names, and other census data:
(If More Than 10 Employees, please call us to
receive a large group census form.)

Employee #1 Name:B-Date: M/F:
Employee #2 Name:B-Date: M/F:
Employee #3 Name:B-Date: M/F:
Employee #4 Name:B-Date: M/F:
Employee #5 Name:B-Date: M/F:
Employee #6 Name:B-Date: M/F:
Employee #7 Name:B-Date: M/F:
Employee #8 Name:B-Date: M/F:
Employee #9 Name:B-Date: M/F:
Employee #10 Name:B-Date: M/F:

 
Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)
 
Employee Health Problems?
(Do any of your employees have special health problems or insurance needs? If no, write "none".)
 
Group Plan Needs?
(Tell us what features you want in your group plan so that we may get the coverage and benefits you are looking for!)

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