VW Brown Insureds - Paid Family & Medical Leave (PFML) Quote Request

Paid Family and Medical Leave (PFML) Quote Request - Alternative to MD FAMLI

Submit information needed to generate quotes for Private Plan Insurance Option, known in Maryland as an Equivalent Private Insurance Plan (EPIP)
Company Name
Contact Name
Email Address
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Tax ID
Nature of Industry or NAICS #
Option 1 - Complete Employee Census Information

(Ideal for groups under 10)

Simply type in your W2 Employee information using census table below. You can add new row for each employee.
Employee Census Table
Option 2 - Complete Employee Census Information

(Ideal for groups over 10)

Upload your census below. Sample template to download as well with the minimum required information for a quote.

VW Brown PFML Census Template for Quote Request
- Once you click the link, use File -> Create a Copy -> Download a Copy to save and edit a census template to upload later.
If you need any assistance, don't hesitate to call, text or email -

Mark Kokosko, CLU®, CLTC®, LACP®

mkokosko@vwbrown.com

(443) 430-0144
Upload Existing Census File (Optional)

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Paid Family and Medical Leave (PFML) Quote Request - Alternative to MD FAMLI