Welch Brand Insurance Services
3970 FM 2181, Suite 200
Hickory Creek, Texas 75065
Phone: 940.220.7232
Fax: 888.310.1660

Email: insurance@ntin.net



Click to read our
Pledge of Performance

 

Counties:
Denton, Dallas, Cooke, Wise, Parker,
Collin and Tarrant

Including the cities of:
Denton, Lake Dallas, Hickory Creek, Corinth, Flower Mound, Lewisville, Argyle, Pilot Point, Plano, Frisco, Dallas, Keller, Forth Worth, Aubry, Sanger and Gainesville

 

Group Health Insurance Quote

Premium quotes are based on the rates effective at the time the quote is made. They are for informational purposes only and are subject to the accuracy of the information provided by the individual requesting the quote.

This is not an implicit offer of insurance. Actual rate quotations are based on an individual customer needs analysis and are calculated with specific information provided by the applicant to the agent.



 

 

 
Products and services are subject to all eligibility requirements stated in the policy.

 
Please compelete the following information and hit the "Submit" button.
 
Group Information:
Name:
Contact Person:
Office Zip Code:
Type of Business:
Phone #:
Fax #:
Email:
 
Employee Census:
(Required) - Please categorize ALL your employees with their desired coverage using the definitions given:
Gender Date of Birth
(mm/dd/yy)		 Coverage
     
Has any employee or dependent incurred medical claims of
more than $5,000 during the past 12 months?
Is anyone currently pregnant?
Has anyone been disabled or confined to a hospital in the
last 6 months?
Are there any other health issues with anyone?

If YES to any of the above, please provide details.
   
Current Coverage:  
Carrier:
Monthly Premiums:
 $
Doctor Co-Pay:
 $
Prescription Co-Pay:
 /
Coinsurance:
Stop Loss:
(max out of pocket / per individual)
 $
Any current medical conditions?: