Click here to download the employee census file (Microsoft Excel):
Employee Census (for PC)

Please fill out this short information form so we may be better prepared to answer your question:

Employer   Administrative Contact

Fax   Phone E-Mail address

Street Address    City      State    ZIP

Current Health Care Provider   Current Dental Care Provider   Current Vision Care Provider   Current Long Term Disability Care Provider   Current Group Life Insurance Provider   Current 401K Provider

Number of Eligible Employees 1-10 10-20 20-50 50-100 100-200 200+ Total Number of Employees   1-10 10-20 20-50 50-100 100-200 200+

Additional Comments:

For information on the following products, please check the appropriate boxes. Medical Plans Point of Service Indemnity Plans Dental Plans DMO PPO Fee for Service Vision 401(k) Long Term Disability Short Term Disability Travel Accident Insurance Key Person Life Insurance Preferred Provider Organizations Exclusive Provider Organizations Health Maintenance Organizations Cafeteria Plans Employee Assistance Plans Estate Planning Deferred Compensation Executive Wage Continuation Flex Plan International Benefits Long Term Care Life and AD&D