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Request a Quote

Every business is unique. That's why we're ready to work with you to get your employees the coverage they deserve.
Complete the form below and an Account Associate will contact you by telephone or email. Of course, you can always call us,
Monday through Friday, 8:30 a.m. to 4:30 p.m. EST, at 1-800-422-3545.

Are you currently working with a broker? *This question is required.
Does your company currently offer Blue Cross Blue Shield of MA insurance? *This question is required.
This form is intended for new business quotes only. If you are an existing BCBSMA group account, please contact your Account Executive directly.
When would you like coverage to be effective?

Within the next: *This question is required.
This question requires a valid email address.
You have indicated your company has 10 or more eligible employees. To best serve you, we recommend calling to speak with an Account Executive directly. Please contact us Monday through Friday, 8:30 a.m. to 4:30 p.m. EST, at 1-800-422-3545.
Employee 1 Information
Type of Coverage *This question is required Date of Birth (MM/DD/YYYY) *This question is required Home ZIP Code *This question is required
1
Employee 2 Information
Type of Coverage *This question is required Date of Birth (MM/DD/YYYY) *This question is required Home ZIP Code *This question is required
2
Employee 3 Information
Type of Coverage *This question is required Date of Birth (MM/DD/YYYY) *This question is required Home ZIP Code *This question is required
3
Employee 4 Information
Type of Coverage *This question is required Date of Birth (MM/DD/YYYY) *This question is required Home ZIP Code *This question is required
4
Employee 5 Information
Type of Coverage *This question is required Date of Birth (MM/DD/YYYY) *This question is required Home ZIP Code *This question is required
5
Employee 6 Information
Type of Coverage *This question is required Date of Birth (MM/DD/YYYY) *This question is required Home ZIP Code *This question is required
6
Employee 7 Information
Type of Coverage *This question is required Date of Birth (MM/DD/YYYY) *This question is required Home ZIP Code *This question is required
7
Employee 8 Information
Type of Coverage *This question is required Date of Birth (MM/DD/YYYY) *This question is required Home ZIP Code *This question is required
8
Employee 9 Information
Type of Coverage *This question is required Date of Birth (MM/DD/YYYY) *This question is required Home ZIP Code *This question is required
9
Are any employees located outside of Massachusetts? *This question is required.
What plans are you interested in learning about? *This question is required.
What products are you interested in learning about? *This question is required.
How would you prefer to be contacted? *This question is required.

Final rates are subject to SIC code verification, underwriting review and actual enrollment as of the plan effective date.

 

Eligible Employees—Permanent full-time employees regularly work 30 or more hours per week and permanent part-time employees working at least 20 hours, but less than 30 hours per week, at the employer's usual place of business and paid in accordance with state & federal wage requirements.

 

 

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