q Group Census Form - Florida Health Insurance Advisors

Group Census Form

Thank you for completing the group health insurance inqury form. We will respond to your inquiry shortly.

For a more accurate quote, please fill out the additional information below.

Please list all full time employees working 25+ hours per week, including those waiving coverage. Please list each dependent on a separate line and add relationship to employee. If adding dependents, must include their DOB, sex and relationship to employee.