Request For Proposal Please enable JavaScript in your browser to complete this form.Email *Name *FirstLastComment or Message *Group Name *Please select a deadline date to receive the quotes back. *DateTimeEffective Date for BenefitsSelect DateJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberGroup Industry/SIC CodePay Deduction FrequencyWeekly (52)Bi-Weekly (26)Semi-Monthly (24)Monthly (12)OtherPlease specify your deduction frequencyGroup Physical AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow many eligible employees? *Are voluntary worksite benefits currently offered? *YesNoUnsurePlease select the current worksite benefits carrier(s):AflacAllstateChubbColonialGuardianMetLifeTransamericaTrustmarkThe HartfordUnumOtherPlease specify the current worksite benefits carrier(s):Please select the current voluntary worksite benefits being offered now:Short Term DisabilityLong Term DisabilityTerm LifeUniversal LifeWhole LifeAccidentCancerCritical Illness without cancerCritical Illness with cancerHospitality IndemnityGapDentalVisionOtherPlease specify the current voluntary worksite benefits being offered:Suggested SES Voluntary BenefitsNot sure, please quote high participation products for this industryVoluntary Short Term DisabilityVoluntary Long Term DisabilityVoluntary Term LifeUniversal LifeWhole LifeLong Term CareCancer InsuranceCritical Illness w/ CancerCritical Illness w/o CancerAccident InsuranceHospital IndemnityIdentity TheftSES Protection Pack (1 combo product -identity theft, legal, roadside, global travel)GapDentalVisionOtherPlease specify suggested voluntary benefits:Special InstructionsWhat core benefits will be offered? *MedicalDentalVisionVoluntary Group Term LifeVoluntary Short Term DisabilityVoluntary Long Term DisabilityEmployer Paid - Basic LifeEmployer Paid - Basic Short Term DisabilityEmployer Paid - Basic Long Term DisabilityHSAFSATelemedicineOtherPlease specify core benefits that will be offered:Please select all services you are interested in for this caseVoluntary Benefits Enrollment + Administration OnlyCore + Voluntary Benefits Enrollment (Open Enrollment Only)Core + Voluntary Benefits Enrollment (Open Enrollment + New Hires)Call Center EnrollmentBen Admin TechnologyEDI Feeds (Carrier Integration)Marketing Materials - Employee Benefits Guide / Communication PiecesOtherPlease specify services you are interested in:CommentSubmit Email [email protected] Address 5805 64th St Suite 11 Lubbock, TX 79424 Phone (806) 773-0775 FollowFollow Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Comment or Message *PhoneSubmit