Group Health Insurance Questionnaire

*For organizations with 8 or more employees / contractors (spouses & children dependents count towards this requirement)

Name *
Name
Do you have an existing group plan? *
When does your group plan expire?
When does your group plan expire?
What type of organization?
How soon do you want to purchase a group plan?
How soon do you want to purchase a group plan?
Which of the following benefits are important to include in your Group Plan? (Please check all that apply)