Eligibility for Small Group (summary) Benefits
1

2
3		 2-50 eligible people (w2, partners, sole proprietors, corporate officers...not 1099) can include part-time or not.
75% of eligible people must go with the plan.
Employer must pay at least 50% of employees premium.		 1
2
3
4		 Plans are guaranteed issue... regardless of health.
Premiums by employer are 100% tax deductible.
Employers can pay as little as 50% of the employees premium.
Can offer choice of plans to each employee.

Send Information to:                                                                                                            I want information on:

First Name

Last Name

company

address

city

state

Coverage is for   
Indiana companies only
zip

  needed for quote
county

Tel

Fax

e-mail

Current Carrier
Company


 Unicare
BCBS of Indiana
No Preference - send least 
     expensive according to 
     selection below 
Medical All Plans
HSA High-ded
No-Deductible  
     Copays PPO
Deductible PPO
HMO
Basic
Dental PPO Dental
HMO Dental

Life 
Include quote 
Please describe your business

Base my request on:                        
Age

Spouse age (leave blank if not covered)

 Children Gender
Employee 1    
Employee 2    
Employee 3    
Employee 4    
Employee 5    
Employee 6    
Employee 7    
Employee 8    
Employee 9    
Employee 10    
Employee 11    
Employee 12    
Employee 13    
Employee 14    
Employee 15    
For groups over 15 
 		 Send me information on P.O.P. which allows 
us to pay premium with pre-tax dollars  
How did you hear about us...
we appreciate your feedback

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