Get A Quote – SB/A CORE HEALTH PLANS

SB/A CoOp Quote Manager

Welcome to the SB/A CoOp Freedom Plan Quote Manager for Employer partially self-funded ERISA regulated health care plans. Please complete the form below so a representative can give you the proper quote for you and your staff.

SB/A CoOp Quote Manager

Employer Contact

Employer Name

Type of Business

Employer Authorized Contact Name

Employer Contact Phone Number

Employer Contact Email Addres

Employee Information

Total Employees

All company employees (enrolling or not)

Total Enrolling Employees

Employees Only

These are employees who do not wish to add dependents (spouse, children, family) to their benefit plan.

Employees + Spouse

These are employees who plan on adding their spouse as a dependent to their benefit plan.

Employees + Child(ren)

These are employees who plan on adding their children as dependents to their benefit plan.

Employees + Family

Employees + Family These are employees who plan on adding multiple dependents (spouse, children, family) to their benefit plan.

Existing Employer Coverage

Does the Employer Have Existing Group Health Coverage

Yes

No

If You Have Existing Group Health Coverage Please Fill This

Current Group Health Coverage

If coverage is now in place, when is the renewal date

How long has the existing coverage has been in place?

Monthly Cost of Existing Coverage

When would you like to have coverage in place?

Questions or Comments