Southern Florida Employee Benefit Health Insurance Quote

We offer affordable Florida group health insurance plan quotes to
businesses located in the following south Florida counties and cities:
Miami-Dade County, Broward County, Palm Beach County, Coral
Gables, Kendall, Richmond Heights, Pinecrest, Howard, Coral Way
Village, Westchester, Westwood Lakes, Brownsville, Sweetwater, Key
Biscayne, North Bay Village, Miami Beach, Miami Springs, Virginia
Gardens, Hialeah, El Portal, Miami Shores, Indian Creek, Surfside, Bal
Harbour, North Miami, Biscayne Park, Pinewood Park, Opa Locka,
Bunche Park, Hialeah Gardens, Palm Springs North, Carol City, Miami,
Norland, Ojus, Miami Lakes, Biscayne Gardens, Hallandale, Sunny Isles
Beach, Golden Beach, Aventura, Uleta, Miramar, Pembroke Pines,
North Miami Beach, Hallandale Beach, Ives Estates, Pembroke Park,
Hollywood, Dania Beach, Cooper City, Davie, Weston, Plantation,
Playland Isles, Melrose Park, Lauderhill, Sunrise, Tamarac, Fort
Lauderdale, Wilton Manors, Oakland Park, Lauderdale Lakes, Sea
Ranch Lakes, Pompano Beach, Margate, Coral Springs, North
Lauderdale, Lighthouse Point, Hillsboro Beach, Coconut Creek,
Deerfield Beach, Boca Raton, The Hamptons, Highland Beach, Boca
West, Delray Beach, Boca Pointe, Boynton Beach, Lantana, Rainbow
Lakes, Atlantis, Lake Worth, South Palm Beach, Palm Springs,
Greenacres, Wellington, Haverhill, Palm Beach, Golden Lakes, Riviera
Beach, Glen Ridge, West Palm Beach, Lake Park, Royal Palm Beach,
Jupiter, Juno Beach, North Palm Beach, Loxahatchee, Belle Glade,
Palm Beach Shores, South Miami, Cutler Ridge, Princeton, Perrine,
Naranja, Homestead, Florida City, and Leisure City, FL

Business Name:
Premises Address:
City: Florida     Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required)
Description of Operations or SIC code:

Current Insurance Company:
Policy Expiration Date:          (mm/dd/yyyy)

Do you currently offer health insurance benefits to employees?
Employee Health Insurance Coverage For:
How many employees to be insured:

HMO Health Insurance   HMO Co-Pay Amount Desired:
PPO Health Insurance     PPO Deductible Amount Desired:
POS Health Insurance     POS Co-Pay Amount Desired:

Choose Benefit Options:
Employee Life Insurance Coverage:
Employee Dental Insurance Coverage:
Employee Vision Insurance Coverage:

Has any employee to be insured experienced serious health
problems during the last 18 months?
If "Yes", please list information below.

Additional Information or Comments

Click on the "Submit Quote Information" button below to send
your Florida employee health insurance plan quote request.

Information received from this south Florida group health insurance quote form sent to Insurance
Benefit Agency will be for our use only and will not be sold, given to or distributed to any other
parties. A quote will be based on the Florida group health insurance information provided and
does not guarantee acceptance of the risk by us. The precise coverage afforded is subject to
meeting underwriting guidelines, and the terms, conditions and exclusions of the policy as
issued. By submitting this request you acknowledge that this is neither an offer to insure nor a
guarantee of insurance. Completion of this form does not entitle you to Florida group health
insurance. We are licensed in Florida only and will not provide health quotes for other states.