If you and your spouse are both separately compensated, full-time owners, officers, partners, and/or employees of your company, and can verify this with officially filed state quarterly (WR30) (MDES-1) (UC-018) (UI-3S) (UI-340) (TWC 3-C) (UC-2A) or annual federal tax documents, enter your information on separate rows. Leave the Spouse column marked "No" for both you and your spouse and list any eligible dependent children only under one of your rows. If you and your spouse cannot provide verifiable tax documentation, it's likely your company is not eligible for a small business group health plan

Yes, you should enter ALL eligible employees, regardless of whether you think they will be applying for insurance. This is because some insurance companies take your total group size into account when determining if your company is eligible for certain plans. Not entering all employees here may cause you to be considered ineligible for plans that you would be otherwise eligible for.

You may enter the information to the best of your knowledge. Insurance premiums are based on gender, home ZIP code, age, the number of family members enrolling, and in some cases on the spouse's Date Of Birth. The more accurate the information you enter, the more accurate your quote will be. Should you need additional assistance, please call one of our live customer service representatives at 888-682-7316 during normal business hours.

You may wish to enter the actual employee names for your convenience, so that you know which employees you've already entered into the form. Using the actual name may also make it easier for you to use our online enrollment option after your application is complete. If you prefer, you may use the employee's initials

Any compensated owner, officer, partner, or permanent employee who works for the company at least 25 hours per week may be eligible to enroll. Employees who receive salary draws or a W-2 should be eligible. Lack of verifiable tax documentation may affect an enrollee's eligibility, which in turn may affect the group's eligibility.

After providing all the information requested on this page, click the View Quotes button to compare your medical plan quotes. It's that simple!

If you indicated that your company has more than 25 employees who will be enrolling in the plan, you will need to enter the information for some of the employees on an additional page on our web site.