Employee Benefits Management in North Carolina
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Employee Benefits Management
Health Insurance in North Carolina
Employee Benefits Management
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Medical Insurance

Medical Census Form

Want a free quote?  Please elect the plan design you desire and provide a current census.

Contact Name:
Company:
Email:
Zip code:
Industry:
         
  Plan I Plan II Plan III Plan IV
Office Co-pay $15/$30 $20/$40 N/A N/A
Rx Co-pay $10/$25/$40 $10/$30/$60 N/A N/A
Deductible $1,000 $2,000 $2,000 $2,750
Coinsurance 100% 80% 80% 100%
Out-of-Pocket Max. $2,000 $4,000 $4,000 $2,750
 
         
Please also include a Dental Proposal
Please also include a Vision Proposal
         
Name Date of Birth Date of Hire Sex Employment Type Coverage Level