Group RFQ (Request For Quote)

Group RFQ (Request For Quote)
Thank you for contacting Seto Health Group. In order to provide you with the best service possible, we kindly request that you fill out the following information to help us better understand your needs and guide you towards suitable plan options.Thank you for your cooperation.
Please follow these 4 steps to complete this form:
1️⃣ Complete the Group RFQ
2️⃣ Upload an updated employee census
3️⃣ Upload a current renewal report (if available)
4️⃣ Schedule a meeting for a presentation of available options
Today's Date
Business Contact Information
Full Name
Title
Company Name
Work/Direct Phone Number
Format: (000) 000-0000.
Email Address
Industry (SIC) Code
Company Website
Company Address

Street Address Line 2

Postal / Zip Code
Zip Code
Current Group Health Coverage
Does your company currently offer Group Health Insurance?
- Current Insurance Company:
- Open Enrollment/Renewal Date:
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit year
- Do you have your current renewal report from your insurance company?
- Upload Renewal Report
  
  Cancelof
- Company Details / Census
- Number of Full Time Employees
- Number of Full Time Employees Enrolled in the Group Health Plan
- Does your company contribute 50% or more towards the employee's health insurance premium?
- Are you interested in reviewing Medicare options for employees age 65 or older?
- Upload Census
  
  Cancelof
- Tell Me Your Story
- Tell me what you would like to improve about your current group health insurance, or anything else you would like me to know.
- Schedule an Appointment
- If you have not already scheduled an appointment, please select a day and time that is convenient for you.
- Did you complete these four steps?
  1️⃣ Completed the Group RFQ
  2️⃣ Uploaded an updated employee census
  3️⃣ Uploaded a current renewal report (if available)
  4️⃣ Scheduled a meeting for a presentation of available options
- How Did You Hear About Us?
Should be Empty: