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(810) 742-5926
10683 S. Saginaw St., Grand Blanc, MI
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AC Financial Group
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Home
Products
All Types of Coverage
Accident Plans
Critical Illness
Dental & Optical
Disability Insurance
Health Insurance
Life Insurance
Long Term Care Insurance
Medicare Supplement Coverage
Medi-Share
Short-Term Medical
Group Rates
Testimonials
Resources
Blog
Insurance Planner
Insurance Calculator
Healthcare Assistance Calculator
Medicare Calculator
About
About AC Financial
Consumer Tips
Contact
Contact Us
Careers
Request Information
Group Insurance Rates
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Your Name
First
Last
Phone
*
Email
*
Agent You're Working With (if Applicable)
Name of Your Business
How Many Employees Are In Your Company
Self-Employed
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
What’s your company’s ZIP?
Your ZIP determines available healthcare plans.
On what date should coverage start?
This helps us understand your timeline and pick appropriate plans.
Would you like the option to contribute to your employees’ dependents coverage?
Dependents will have access to group coverage regardless of your contribution choice. You can change this setting at any time.
Yes
No
I'll Decide Later
Employee #1
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #2
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #3
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #4
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #5
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #6
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #7
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #8
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #9
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #10
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #11
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #12
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #13
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #14
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #15
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #16
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #17
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #18
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #19
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #20
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #21
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #22
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #23
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #24
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employee #25
Name
First
Last
Age
Out of State?
No
Yes
Gender?
Male
Female
Spouse?
No
Yes
# of Children
0
1
2
3
4
5
Employer Contribution
Do you plan on contributing dollars to your employees healthcare costs?
Yes
No
What percentage per employee are you estimating that you as the employer would contribute?
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