Thank you for the opportunity to quote employee benefits for your company.

Here are two convenient options for you to request quotes:
 
1.
Complete your request with the On-Line Quote Request Form (please scroll below).
 
  2. You may also download our Quote Request Form (an Excel spreadsheet). Simply right-click on this link and then choose "Save Target As" to save this document in a folder of your choice.

Please e-mail the completed form as an e-mail attachment to quotes@newenglandbenefits.com.
 
   
Call us anytime if you have questions at 978-247-6090

On-Line Quote Request Form
 
1. Tell Us About Your Company
* This information is required to quote benefits.
 
*Your Name:   
*Your Title:   
*Company Name:   
*Street Address:   
*City, State ZIP:   , 
*Phone Number:   
Fax Number:   
*Nature of Business:   
Your e-mail address:   
*Date Company Started:     MM/DD/YYYY
*Benefit Coverage Start Date:     MM/DD/YYYY
 
2. Tell Us About Your Employees
 
Please enter information for all "eligible" employees including those planning to waive coverage.
 
An "Eligible Employee" is defined as a full-time employee regularly working 30 or more hours per week (including owners) and paid in accordance with state and federal wage requirements. For the purpose of meeting minimum participation requirements, an employee may be waived from the number of eligible employees if he or she:

  • Is covered under the group plan of a spouse or parent;
  • Lives outside of the insurance company's service area;
  • Is covered under Medicare.

Columns 1 to 5: Health and Dental Insurance quotes require this information. Columns 6 to 8: This additional information is required to quote group life and short/long term disability insurance coverage.
  1 2 3 4 5 6 7 8
# Employee Name or Initials(Optional) Date of Birth Home Zip Code State Coverage Type Gender Weekly Salary/
Wages		 Occupation/
Job Title
 
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15


3. Employee Benefits Survey

To provide you with the best available benefit options, please tell us about your needs:
               
Health Insurance
Tell us about each health plan you currently offer to your employees:
  Current Premium Information
      Plan Type Insurance Co. Employee Only Employee+1 Family
Health Plan 1   
What percentage or dollar amount does the
company contribute toward premiums for this plan? 
 
  Current Premium Information
      Plan Type Insurance Co. Employee Only Employee+1 Family
Health Plan 2   
What percentage or dollar amount does the
company contribute toward premiums for this plan? 
 
We will quote the best health plans available based upon your employee data and your existing plans. Please provide any additional instructions:
 
 
Dental Insurance
Tell us about each health plan you currently offer to your employees:
  Current Premium Information
      Plan Type Insurance Co. Employee Only Employee+1 Family
Dental Plan 1   
What percentage or dollar amount does the
company contribute toward premiums for this plan? 
 
  Current Premium Information
      Plan Type Insurance Co. Employee Only Employee+1 Family
Dental Plan 2   
What percentage or dollar amount does the
company contribute toward premiums for this plan? 
 
 
We will quote the best dental plans available based upon your employee data and your existing plans. Please provide any additional instructions:
 
 
Please check all additional benefits you have and/or would like us to quote.
 
  Your Existing Benefits Your Desired Benefits Tell us more about your needs
Life Insurance
Short-Term Disability Insurance
Long-Term Disability Insurance
401(k) Plans
Section 125 Plans
Flexible Spending Accounts
Vision Plans
Employee Discount Tickets
Pet Insurance
Credit Union
Long-Term Care
 
Referred by: