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Group Insurance

If you are an employer with at least one employee for whom you are paying or contributing toward medical insurance premium costs, you qualify for group insurance under Oregon law. As such, the underwriting and rating systems are different than individual medical insurance (guarantee issue, average age based rates, etc.). Generally each group is rated independently and published rates do not exist. To obtain rates, a census must be submitted to each carrier…if you qualify and would like rates for your group please:

  • Provide census data
  • Answer the short questionnaire
  • E-mail or print off and fax (503.291.1657)

We may need to contact you for additional information in certain situations. For example, some carriers requires some form of verification of business structure for groups of under 4 employees, etc. It generally takes 7 – 10 days to get responses back from all the carriers – at that point we will prepare a comparison of the plans and contact you.

(Fields in red are required)

COMPANY INFORMATION

Company Name
Type of Business
Street Address
(NOT a PO Box)
City, State  Zip
Contact Person Phone Number
E-Mail Fax Number
Best Time to Call # of Employees
(Include Employer)

DESIRED BENEFITS & OTHER INFORMATION

If you have an existing group plan in place please enter the insurance company name here.

To the extent that you have specific benefits in mind, please indicate below.
(Otherwise we will give you a range of benefits designs)
Traditional Major Medical or PPO   
  Deductible  $250 $500 $1,000
HMO or Point of Service   
  Office Co-pay $10 $15 $25

Additional Coverages
Dental     Yes   No
Life     Yes   No
Disability     Yes   No

If you do not want to consider specific insurance companies, please list them here.
Any other comments?

EMPLOYEE INFORMATION

-------------  One entry for each employee  ------------- Additional Insureds
Employee Name Birthdate Spouse # Children

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