Request a quote

Ready to take the next step in offering health insurance to your employees? Fill out this form and we’ll contact you to provide a preliminary price quote. Final rates are based on group eligibility and completed applications for eligible employees.

Request a preliminary price quote

Company name: Your name: Company address: City: State: Zip code: County: Phone number: Email address: Requested effective date of coverage (must be 1st of month) Broker name, if applicable

Total company employees

The number of total company employees should include employees at all locations, full-time, part-time, those electing coverage and those waiving coverage.

Total eligible employees

The number of employees eligible for health insurance coverage

Total electing coverage

The number of employees electing coverage Do you have a current effective group health insurance policy? Yes No

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Geisinger College of Health Sciences

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Small business (1-50 employees)