Group Health Insurance Quote Maryland

Business Name:
Premises Address:
City:
MARYLAND     Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required)
Description of Operations or SIC code:

Current Insurance Company:
Policy Expiration Date:          (mm/dd/yyyy)

Employee Information:

Do you currently offer health insurance benefits to employees?
Group Health Insurance Coverage For:
How many employees to be insured:

Maryland Group Health Insurance Coverage Desired:

HMO Group Health Insurance   HMO Co-Pay Amount Desired:
PPO Group Health Insurance     PPO Deductible Amount Desired:
POS Group Health Insurance     POS Co-Pay Amount Desired:
Fee-for-Service Insurance          Fee-for-Service Deductible:

Choose Benefit Options:
Group Dental Insurance Coverage:
Group Vision Insurance Coverage:
Group Life Insurance Coverage:

Has any employee to be insured experienced serious
health problems during the last 18 months?

Additional Question or Comment:

Click on the "Submit Quote Information" button below to send
your Maryland Group Health Insurance quote request.**

**Information received from this Maryland Group Health Insurance quote
form sent to Upper Chesapeake Insurance Agency, will be for our use only
and will not be sold, given to or distributed to any other parties. A quote
will be based on the group health insurance policy information
provided and does not guarantee acceptance of the risk by us. The
precise coverage afforded is subject to meeting underwriting
guidelines, and the terms, conditions and exclusions of the policy
as issued. By submitting this request you acknowledge that this is
neither an offer to insure nor a guarantee of insurance. Completion
of this form does not entitle your small business to Group Health Insurance
in Maryland. We are licensed in Maryland and will not provide group
health insurance quotes for other states.

We are a Baltimore, MD full service insurance agency, offering comprehensive
Maryland group health insurance quotes to businesses located in the following
neighborhoods, cities and counties: Federal Hill, Locust Point, Canton, Fells
Point, Bolton Hill, Butchers Hill, Dundalk, Essex, Baltimore Highlands,
Lansdowne, Middle River, Rosedale, Arundel Village, Brooklyn Park,
Kenwood, Eastpoint, North Point, Chesaco Park, Rossville, Halethorpe,
Elkridge, Linthicum, Glen Burnie, Rippling Ridge, Garland, Ferndale,
Woodlawn Heights, South Gate, Severn, Catonsville, Shipley, Arbutus, West
Edmondale, High Point, Riviera Beach, Green Haven, Orchard Beach, Lipins
Corner, Ellicott City, Lochearn, Brighton, Woodmoor, Rockdale, Lynne Acres,
Pikesville, Randallstown, Owings Mills, Garrison, Towson, Mays Chapel,
Overlea, Parkville, Carney, Perry Hall, Elmwood, Edgemere, North Point
Village, Rodgers Forge, Ruxton, Linhigh, Fullerton, Putty Hill, Baynesville,
Lutherville-Timonium, Annapolis, Columbia, Hampton, Providence,
Montgomery County, Carroll County, Prince Georges County, Howard County,
Anne Arundel County, Harford County, and Baltimore County, MD. We also
offer Maryland group health insurance quotes throughout the Old Line State.