Request for Quotes

Agent Information

Agency/Agent

Email

Phone Number

Group Information

Group Name

Type of Industry

State

Number of Eligible Employees

Total Number of Employees

Description of Eligible Class

Plan Information

Does group have a plan in place?

Yes (If Yes, Provide Copy Of Current Plan)
No

Target Effective Date*
*Effective date must be the first of the month

Name of Carrier

Number of Current Enrolled

Is Census Available?

Yes
No

Renewal Date

Renewal Rate Action (explain)

Benefit Information

Carrier

Standard Security
Nationwide

Employer Contribution Amount (%)

Quote Request for

Employer Paid Rates (Must Have Min 50% Contribution Towards The Employee Rate)
Voluntary Rates (Nationwide Requires A Min 100 Eligible)

Target Price Points

If Other Explain Here

Number of Plans to be offered

Standard Security

1 (1-50 Eligible)
2 (51-250 Eligible)
3 (251+ Eligible)

Nationwide

1 (1-50 Eligible)
2 (51-500 Eligible)
3 (500+ Eligible)

Additional Products

Additional Benefit:

Tiered RX

Additional Benefit: :: The Health Savings Program is included in all plans. It includes discounts on Chiropractic, Hearing, Nurse Hotline, Phone Counseling, Vision, Vitamins and Nutritional Supplements

Enrollment Method

Paper
Feed (100 Enrolled Min)
Online

Groups with 1000+ Eligible Lives TO: Got a case with over 1000 eligible lives? We’ve got great enrollment and administration strategies.
Click Here to contact our National Accounts Team.

Please verify the letters.

Please verify the letters. :: The letters are case sensitve.

Thank you for your submission. Quotes are provided within 24-48 hours of receipt. Requests may also be submitted to quote@frameworkhealthplan.com or faxed to Framework Health at 512.349.4765.

Agent Information

Group Information

Plan Information

Benefit Information

Groups with 1000+ Eligible Lives TO: Got a case with over 1000 eligible lives? We’ve got great enrollment and administration strategies.
Click Here to contact our National Accounts Team.

Sell

Educate

Framework Health Plan

Agent Information

Group Information

Plan Information

Benefit Information

Groups with 1000+ Eligible Lives TO: Got a case with over 1000 eligible lives? We’ve got great enrollment and administration strategies. Click Here to contact our National Accounts Team.

Sell

Educate

Framework Health Plan

Groups with 1000+ Eligible Lives TO: Got a case with over 1000 eligible lives? We’ve got great enrollment and administration strategies.
Click Here to contact our National Accounts Team.