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About Us
Our Mission and Promise
Our History
Key Personnel
Professional Affiliations
HWP Insurance News
Client Testimonials
Business
Product Offerings Overview
Cyber Liability Insurance
Professional Liability Insurance
Property Coverages
Fiduciary & Crime Coverages
Workers Compensation
Commercial Auto
Surety & Bonding
International Coverages
General Liability
Dedicated Units
Construction
Non-Profit & Social Services
Small Business
Benefits
Employee Benefits Consulting & Support
Human Resources
Executive Programs and Business Consulting
Life Insurance
MyWave® Portal
Personal
Auto Insurance
Homeowners Insurance
Life Insurance
Resource Center
White Papers and EBooks
Webcasts/Training Events
MyWave® Portal
HWP Gives Back
Contact Us
Group Quote
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Group Quote
Howard W. Phillips & Co.
2017-06-16T13:12:24-04:00
Group Quote
General Information
Contact Name
*
Contact Email
*
Name of Business
Nature of Business
Address
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
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Niger
Nigeria
Norway
Oman
Pakistan
Palestinian Territory
Palau
Panama
Papua New Guinea
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Peru
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Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
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Samoa
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Spain
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Sweden
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Syria
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Tuvalu
Uganda
Ukraine
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Uruguay
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Vanuatu
Vatican City
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Vietnam
Western Sahara
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Yemen
Zambia
Zimbabwe
Country
Business Phone
Fax
Life and AD&D Coverage
Number of Employees
Number of Employees Eligible
Current Carrier
Renewal Date
Current Rate
Renewal Rate
Flat Amount
Group Health Coverage
Number of Employees
Number of Employees Eligible
Current Plan
HMO
POS
PPO
Indemnity
Plan to Quote
HMO
POS
PPO
Indemnity
Desired Deductible
Desired Co-Pay
Desired Co-Insurance
Group Dental Coverage
Number of Employees
Number of Employees Eligible
Class A Deductible
Class B Deductible
Class C Deductible
Class A Co-Insurance
Class B Co-Insurance
Class C Co-Insurance
Calendar Year Maximum
Group Disability Coverage
Number of Employees
Number of Employees Eligible
Current Plan
STD
LTD
Current Carrier
Renewal Date
Current Rates STD
Renewal Rates STD
Elimination Period STD
Percentage Payable STD
Maximum Benefit STD
Duration Benefits STD
Current Rates LTD
Renewal Rates LTD
Elimination Period LTD
Percentage Payable LTD
Maximum Benefit LTD
Duration Benefits LTD
Comments
Employee census information including Date of Birth, Sex, Job Title and Earnings will be required. Loss Information will be helpful and may be required on groups over 100 lives.
Please note any other pertinent information or requests for coverages:
Would you like this directed to a specific agent?
*
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No
Agent Name
How did you hear about us?
Disclaimer Notice
*
The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.
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