Medical Quoting Information – Small Group Fully Insured (ACA) – ACA Quoting Census
AgentLink can quote Anthem, United Healthcare and Humana for fully insured health coverage.
- Requested Effective Date
- Groups full name
- Groups full address (make sure to include zip code)
- Group SIC Code
- Writing Agent Information
- Information for all eligible employees and their dependents to be quoted:
- Date of birth for employee and all dependents
- Gender for employee and all dependents
*The above can also be used to quote dental, vision, and basic life for the groups with most carriers*
Life and Disability Quoting – Small Group
We can quote Principal, Guardian, Lincoln, Metlife for life and disability products as well as the medical carriers listed above.
- Requested effective date
- Groups full name
- Groups full address (make sure to include zip code)
- Group SIC Code
- Writing Agent Information
- If group has current coverage – current plan designs and rates
- Information for all eligible employees and their dependents to be quoted:
- Employee and eligible dependents full name
- Employee and eligible dependents date of birth
- Employee and eligible dependents gender
- Employee occupations (STD, LTD and salary-based life only)
- Home zip code
- Employee salary amounts (Salary based life only)
- Employee work zip codes (if multi-site location)
Medical Quoting Information – Small Group Anthem Chamber (MEWA) – Anthem Chamber IN and Anthem Chamber KY
Anthem Chamber can be quoted for Kentucky and Indiana only.
- Chamber Quote Request Form
- Individual Health Questionnaires (Varies by state)
- Chamber Census Tool
- MEWA Employer Questionnaire – INDIANA only
Medical Quoting Information – Small Group United Healthcare Level Funded – UHC LFP Quoting Forms
United LFP products are only offered to groups of 5 or more.
- 5-9 enrolled or virgin groups:
- Individual employee applications
- Quoting Questionnaire
- 10 enrolled – 50 eligible:
- Member Level Census (created by UHC)
- Quoting Questionnaire
Medical Quoting Information – Small Group Humana Level Funded – Humana LFP Quoting Forms
Humana LFP products require 5 enrolled.
- HRAE Form
- Census
- Renewal (if they have current coverage)
- Member applications if under 10 enrolling or virgin group
Medical Quoting Information – Small Group Humana Association – Humana Association Quoting Forms
Humana Association is only available in Kentucky.
- HRAE Form
- Census
- Renewal (if they have current coverage)
- Member applications if under 10 enrolling or virgin group
All forms mentioned are available upon request. Please reach out to anyone on our sales team to assist.
