Group Plan Quote Form














































Insurance plans ofFlorida is an independant agency representing all of the leading group insurance carriers for health, life, dental, vision and disability plans. We can provide companies who would like to control costs but maintain an attractive benefit package for their employees. Please fill out the following information so that we can assist you.














































Business Name:














































Nature of Business:














































Present Insurance Company:














































Renewel Date of Current Plan:














































Coverage Types:
(check all that apply)














































Contact Name:














































Email:














































Day time Phone:














































Address:














































City:














































Zip:






































































































































































































































HMO














































PPO














































POS














































Dental













































Complete census form for all employees participating in the health plan.









































Name









































Gender









































DOB or Age









































Spouse's Age









































#of kids









































Zipcode







































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