The Cason Group
 

  UNDER 50 GROUP ONLINE QUOTE REQUEST

Thanks for visitng The Cason Group Request for Quote page. For each line of coverage please supply all the requested information. Incomplete information will delay us in getting you the most competitive rates for your group! If you have any questions please contact your Marketing Representative or service@thecasongroup.com.
General Information
Agent Information
Agent Name:
Agent Company:
Agent City:
Agent State:
Agent Phone:
Agent Fax:
Agent Email:
Preferred
Reply:
 E-mail
US Mail
Facsimile
Group Information
Group
Name:		 City:
Group State: Group Zip:
Other Locations:
Nature of Business:
Effective Date :
Desired Benefits
Life Insurance: Yes No
Flat Amount:
Class 1:
Multiple of Salary:
Class 2:
Employer
Contribution:
Class 3:
Takeover: Yes No
Class 4:
Voluntary: Yes No
Medical Insurance: Yes No
Medical Deductible: Plan Types (e.g. POS/HSA):
Supplemental Accident:
Medical Drug Card:
 Yes No
Coinsurance %:    
Out Of Pocket:
Copay:
Dental Insurance: Yes No
Employer Contribution:
Dental Max:
Dental Orthodontics:
 Yes No
Takeover:
 Yes No
Voluntary:
 Yes No    
Short Term Disability: Yes No
Day
duration:
   
Day
accident:
Day
sickness:
Coverage amounts:
%
to
$
  Or flat $
Takeover:
 Yes No      
Employer Contribution:
Voluntary:
 Yes No          
Long Term Disability: Yes No
Day Elimination Period
%
  to
 $
 
Duration:
    
Own Occupation:
 
Takeover:
 Yes No    
Employer Contribution:
 
Voluntary:
 Yes No          
 
General Notes:
    
EMPLOYEE CENSUS INFORMATION
Please complete one row for each employee:
Last Name First Name DOB/Age Sex Spouse Age # Of
Children		 Zip
Code		 Family
Coverage		 Occupation
(If App.)		 Classes
(If App.)		 Salary
(If App.)
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Copyright ® 2005 The Cason Group

 

Authorized Agent for BlueChoice HealthPlan and BlueCross BlueShield of South Carolina.

BlueChoice HealthPlan is a wholly owned subsidiary of BlueCross BlueShield of South Carolina. Both are independent licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. "BlueCross", "BlueShield" and "BlueChoice" are registered marks of the Blue Cross and Blue Shield Association