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 offer group health coverage?

Yes No

Cancel

Employee household census

Add one card per employee. Spouse and child information stays grouped inside that employee's card, including one optional notes box for the whole family.

Please do not enter Social Security numbers or policy numbers. Family medications, health concerns, doctors and questions may be summarized together in the optional box. If a carrier needs more detail, Desmond will explain the approved way to provide it.

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 group 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.

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Your group census was sent.

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

Book a follow-up appointment