Colorado Small Business Health Insurance featuring Blue Cross Blue Shield of Colorado insurance

Colorado health insurance Small Business proposal

Send Information to: I want information on:

First Name
Last Name
company
address
city
state	Coverage is for Colorado companies only
zip
county
Tel
Fax
e-mail

Company	Blue Cross/Blue Shield No Preference - send least expensive according to selection below
Medical	All Plans MSA High-ded No-Deductible Copays PPO Deductible PPO HMO Basic
Dental	PPO Dental HMO Dental
Life	Include quote

Current Group Coverage?		Monthly Premium
Articles of Incorporation available?
Tax and wage records available
At least one employee on payroll
Any major conditions, such as diabetes, cancer, heart attack with one year for any employee?
Current medications
Type of Business

Base my request on:

	Date of Birth	Employee Zip	Dependents	Gender	Declining coverage
Employee 1
Employee 2
Employee 3
Employee 4
Employee 5
Employee 6
Employee 7
Employee 8
Employee 9
Employee 10
Employee 11
Employee 12
Employee 13
Employee 14
Employee 15
For groups over 15	Send me information on P.O.P. which allows us to pay premium with pre-tax dollars
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an independent insurance agency serving Colorado Health Insurance needs.