The form that starts below contains 12 questions about your company insurance needs. This form is followed by a short form requesting contact and address information we can use to deliver a quote. For privacy concerns, please review our privacy policy.

If you'd like to communicate with us directly for assistance with this process, please feel free to give us a call at: 503-241-8164 or toll free at 800-941-8131.



1) Please indicate the total number of employees, including yourself, who are eligible for this group health insurance plan: (definition of an eligible employee)
 
  1. Please indicate the exact number
2) Do you currently offer group health insurance coverage?
 



  • If yes, please provide the health plan & expiration date:
3) If you do currently offer a group health plan to your employees, what types of benefits are available?
 
  • None currently
    HMO
    PPO
    POS (Point of Service)
    Self-insured
    Other (or not sure)
4) What types of health insurance plans are you currently considering?
 
  • Not sure - please help me to determine the best plan
    HMO - managed care system with strict in-network requirements
    PPO - more flexible system; permits out-of-network visits
    POS - most flexible managed care system; open access to
             providers with plan covering a lower percentage of costs
             from out-of-network providers
    Self-insured - employees deposit premiums into company
             health insurance fund (40 or more employer-sized group)

 
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