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Health Insurance as easy as 1-2-3

• 1 - Instant Quote
• 2 - Compare Plans
• 3 - Apply Online

Group Health Insurance Quote

Company Details

Business Name

Address

City

State

Zip Code

Phone Number

Alternative Phone Number

Email Address

Standard Industrial Classification

(If you don't know click here to look it up)

Coverage Details

When would you like coverage to start?

Will this replace existing insurance?

Yes

No

Number of Enrolling Employees Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Note: If you wish to enroll more than 50 employees please call us for a quote at (208) 344-3388.

Employee Details

Employee Name	Gender	Date of Birth	Add Spouse	Spouse Date of Birth	Number of Children
	M F		Spouse		None 1 2 3 4 5 6 7 8 9 10
	M F		Spouse		None 1 2 3 4 5 6 7 8 9 10
	M F		Spouse		None 1 2 3 4 5 6 7 8 9 10
	M F		Spouse		None 1 2 3 4 5 6 7 8 9 10
	M F		Spouse		None 1 2 3 4 5 6 7 8 9 10
	M F		Spouse		None 1 2 3 4 5 6 7 8 9 10
	M F		Spouse		None 1 2 3 4 5 6 7 8 9 10
	M F		Spouse		None 1 2 3 4 5 6 7 8 9 10
	M F		Spouse		None 1 2 3 4 5 6 7 8 9 10
	M F		Spouse		None 1 2 3 4 5 6 7 8 9 10

INSURERS OF IDAHO
Treasure Valley: (208) 344-3388  •  Toll Free: (877) 609-9969
moreinfo@insurersofidaho.com
© 2012 Insurers of Idaho

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