• Complete Proposal Request Form
• Census with the following minimum information for all enrolling members:
  • ​First Name
  • Last Name
  • Date of Birth
  • Coverage Tier (EE, ES, EC, or EF)
  • Noted if they are enrolling, waiving or in waiting period​

​Once all required information is received, please allow 2-3 business days for Illustrative Rates.

• Will need Individual Health Questionnaires for final rates

Please contact our Marketing Department at 1-800-675-1233
​to get our most recent Proposal Request form or Heath Questionnaires.