Contact us for a quote:
All companies from 3 to 49 employees, we need the following:

Company Name: Zip:
 
Email Address Phone
( ) -
Single:     EE/Spouse:
EE/Child:     Full Family:

If you employ greater than 50 employees we also need the following:

Age:     Sex:
Marital Status:     Residential ZIP Code:
Please fax the above information to: 631-666-1505.

If you would like us to make a comparison of benefits and premium we also need the following:

Your Current Plan Type (select one):
HMO  POS  PPO  INDEMNITY
Deductible:     Co-Insurance:
Stop Loss:     Doctor/Lab Visit:

RX Card Co-pay:
Generic $   Brand $  
Formulary $   Deductible $  
Employee Premium:
Single:     EE/Spouse:
EE/Child:     Full Family:
65 & Over:     Monthly Premium:
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