Health Insurance Shopping Form

We’ll quote multiple carriers for you.

Moran Benefits - Online Quote form

Are you interested in individual or group coverage?(Required)
A group plan covers employees of a business; an individual plan covers just you and your family
Your Name
Address
Business Codes
NAICS: North American Industry Classification System SIC: Standard Industrial Code Don't know yours? NAICS Search and SIC Search
NAICS Code
SIC Code
 
MM slash DD slash YYYY
You can enter employee data in the chart below by clicking the 'Add Employee' button and following the prompts. OPTIONAL: If you would rather send us employee data via excel spreadsheet click to download our template file. After completion, use the 'Select File' button below to upload your completed census template.
Employee Details
Employee Name
DOB
Gender
Enroll/Waive
Zip
Spouse DOB
# of Children Enrolling
Children #1 DOB
Children #2 DOB
Children #3 DOB
Children #4 DOB
 
See directions and template above.
Drop files here or
Accepted file types: xlsx, csv, Max. file size: 32 MB.
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