"We make buying Health Insurance as simple as possible!"
California Health Insurance License #0436537

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Personalized
Health Quote

(We Shop Multiple Carriers,
For Plans That Suit You)

Short Term Health Insurance
(Need Temporary Coverage?)

HCC Life Insurance Company
"Short Term Plan"

Vision Plan Of America
(Dental Avaliable)

Group Health Plans

Travel Insurance

About our Agency

 

GROUP HEALTH PLANS

We'll attempt to save you money and improve your group health insurance coverage. Rates can change monthly and your current plan may be improved upon for both price and benefits. Please click here: "Group Health" for your easy online quote form .  We would like to mail you a real comprehensive portfolio of all rates and benefits from all the major California health insurance companies.


        

Group Health Insurance
Quotation Form
One Simple Form - takes only 2-3 Minutes!


Your Personal/Group Data:


 
Your Name:
Your Business Name:
Street Address:
City:
State: (Must be California)
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Group Details
(If more than 5 in group, contact us at:
1-800-556-7176)

Please Check the Group Products your company wants
to make available to your employees:

Group Health   Group Dental   Group Vision
Group Life   Employee Benefits
 

Underwriting Information:

 
List employees' names, and other census data:
(If More Than 5 Employees, place call us to
receive a large group census form.)

 

Employee #1 Name M/F Age Status
       
Zip Code Payroll Type
(W2 or 1099?)
Currently Insured? Plan type
     
Employee #2 Name M/F Age Status
       
Zip Code Payroll Type
(W2 or 1099?)
Currently Insured? Plan type
     
Employee #3 Name M/F Age Status
       
Zip Code Payroll Type
(W2 or 1099?)
Currently Insured? Plan type
     
Employee #4 Name M/F Age Status
       
Zip Code Payroll Type
(W2 or 1099?)
Currently Insured? Plan type
     
Employee #5 Name M/F Age Status
       
Zip Code Payroll Type
(W2 or 1099?)
Currently Insured? Plan type
     

 
Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)
 
Employee Health Problems?
(Do any of your employees have special health problems or insurance needs? If no, write "none".)
 
Group Plan Needs?
(Tell us what features you want in your group plan so that we may get the coverage and benefits you are looking for!)
 

 

Send my quotation via: Fax
Regular Mail
Call Me by Phone
 

 

Thank you for filling out this formCOMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

 

Yes, I Agree. Please Send Me a
Group Insurance Quote NOW!

 

 

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Contact us Today at:

Ablitz Health Insurance
California Insurance License #0436537
Phone: 1-800-556-7176 / Fax: 1-818-557-1371
E-Mail us at:
enroll@ablitzhealthinsurance.com