Max Sadlak Agency, Inc.

Group Quote

General Information
Contact Name *
Contact Email *

Name of Business
Nature of Business
Address
City
State
Zip
Business Phone
Fax
Life and AD&D Coverage
Number of Employees
Number of Employees Eligible
Current Carrier
Renewal Date
Current Rate
Renewal Rate
Flat Amount
Group Health Coverage
Number of Employees
Number of Employees Eligible
Current Plan HMO  POS  PPO  Indemnity
Plan to Quote HMO  POS  PPO  Indemnity
Desired Deductible
Desired Co-Pay
Desired Co-Insurance
Group Dental Coverage
Number of Employees
Number of Employees Eligible

Class A Deductible
Class B Deductible
Class C Deductible

Class A Co-Insurance
Class B Co-Insurance
Class C Co-Insurance
Calendar Year Maximum
Group Disability Coverage
Number of Employees
Number of Employees Eligible
Current Plan STD  LTD
Current Carrier
Renewal Date

Current Rates STD
Renewal Rates STD
Elimination Period STD
Percentage Payable STD
Maximum Benefit STD
Duration Benefits STD

Current Rates LTD
Renewal Rates LTD
Elimination Period LTD
Percentage Payable LTD
Maximum Benefit LTD
Duration Benefits LTD
Comments
Employee census information including Date of Birth, Sex, Job Title and Earnings will be required. Loss Information will be helpful and may be required on groups over 100 lives.
Please note any other pertinent information or requests for coverages
* = Required Field
Disclaimer Notice - The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.

 

 

AARP TheTravelersAutoInsurance MaxSadlak

Insurance News

Fri, 14 Oct 2011 21:38:05 GMT
As the summer ramps up and the warm days turn to hot days many people will be spending a lot of time out on the water. Whether you’re taking the boat out for a weekend or renting personal water crafts on a summer vacation, it’s important to rememb...
Fri, 14 Oct 2011 21:38:03 GMT
It’s a rite of passage for college students to don cap and gown and march across the stage for graduation ceremonies- in fact, according to the National Center for Education Statistics (NCES) nearly 1.8 million students will graduate with a bachelor...
Fri, 11 May 2012 18:01:21 GMT
May is National Moving Month and every year more than 40 million Americans will move, according to the American Moving and Storage Association. As you pack up your belongings and move across town or across the country, make sure you don’t forget to ...
Thu, 19 Apr 2012 14:11:26 GMT
"I recognize the right and duty of this generation to develop and use the natural resources of our land; but I do not recognize the right to waste them, or to rob, by wasteful use, the generations that come after us." – Theodore Roosevelt With Earth...
Fri, 14 Oct 2011 21:38:04 GMT
Tips for dealing with tornadoes from Trusted Choice.