Small business coverage

Tell me about your group.

Complete one organized census so I can review available employee coverage options and follow up with the right questions.

One licensed brokerNothing is soldNo Social Security numbers

Step 1 of 3About 5 minutes

Please complete the required fields before continuing.

Business information

Start with the company and the person Desmond should contact.

Business name

Contact person

Email address

Phone number

Business address

City

State

ZIP code

Eligible employees

Do you currently have health coverage?

Yes No

Cancel

Employee household census

Add one card per employee. Spouse and child information stays grouped inside that employee’s card.

Do not include Social Security numbers, payment details, medical conditions or medications. Contact Desmond to arrange a secure process for sensitive information.

Coverage preferences

These details help narrow the first round of options. Estimates are not approval or a guarantee of coverage.

Desired effective date

Current carrier (optional)

Current monthly premium (optional)

Employer contribution (optional)

Goals or questions (optional)

BusinessContact

1 employee household listedDependents grouped with each employee

The census could not be sent. Please try again or email Desmond.

✓

Your group census was received.

Desmond will review the details and follow up personally about available options and anything else needed.

Book a follow-up appointment

Please do not enter payment card numbers, Social Security numbers, medical diagnoses or medication details. Ask Desmond for the appropriate secure process if more information is needed.