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Group Life Insurance

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Group life insurance policies provide coverage for all eligible employees regardless of medical condition, subject to a "non-medical" limit.  Employees may need to provide medical information or take a medical examination to receive coverage beyond this limit.

One advantage of salary-based coverage is that the policy does not need to be adjusted for inflation.
 

The following provisions are often added to group term life policies and may result in a higher premium:
 

     Accidental death & dismemberment:

         Provides coverage for death or bodily injury by accidental means (other than natural causes).

     Accelerated death benefits:

         Allows employees to receive benefits (a portion of their proceeds) if they are diagnosed with a a terminal illness.

     Waiver of premium:

         If an employee becomes totally disabled, allows continued insurance coverage without requiring premium payments.

     Conversion:

         Allows employees to convert group coverage to an individual policy upon termination of their employment.

 

The following causes of death are often excluded from life insurance policies:

 

     Acts of war

     Acts of crime

     Suicide(during the first two years the policy is in effect)

 

We will automatically show you multiple plan options when we quote group life insurance.

 

The information required for quoting life insurance is similar to health and dental insurance.  Therefore, if you have already completed our census information for heath, vision, and/or dental, you do not need to complete this form again.

 

  *Please Provide as much information as possible to assure the most accurate quotes.  Leave blank if you are not sure of an answer.

  *See our Privacy policy for confidentiality.

     General Information

      This section only needs to be completed once for multiple lines of coverage

 

Name of Business:

Name of Owners/Officers:

 

Contact Name:

Contact Phone & Fax:

 Phone:    Fax:

Contact E-mail Address:

Address:

 

City:

 

   State:    Zip:

Business Info:

C-Corporation
S-Corporation
LLC                

Sole-Proprietor

Partnership

LLP/Other

 Years in Business:

Fed. Tax ID or Social Security Number:

Business Description:

     Current/Previous Insurance Information

Current insurance company:

 

Describe Your Current

 Life Plan:

Policy Period:

 Effective Date:    Expiration Date:

     Census Data Information

*Important Note*

 

If you have more than 10 employees, please enter their census information in the "additional information" section or provide us with a spreadsheet or list.

 

Employee Name

Sex

Salary

DOB/AGE

Employee's

State

Zipcode

 M 
 F 

$

 M 
 F 

$

 M 
 F 

$

 M 
 F 

$

 M 
 F 

$

 M 
 F 

$

 M 
 F 

$

 M 
 F 

$

 M 
 F 

$

 M 
 F 

$

 

     Additional Comments & Information

Please tell us anything else you think might be helpful to know in order to provide accurate insurance quotes:

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