713.527.0444 :: 1.888.266.2680 | 3131 West Alabama, 4th Floor | Houston, Texas 77098
 

Benefit Solutions: Group Health Benefits

Benefits solutions group benefitsThere is a lot of competition for top employees, and it is no secret that the group health and life insurance available is often the deciding factor when an employee decides which company to work for. Dean & Draper is proud to offer a variety of group packages that will help your company attract the best.

The following documents will be needed to provide a quote.

Census (Excel)
Census (PDF)
Medical Assessment (Word)

For more information, please call 1.888.266.0444 or 713.527.0444

Tell Us About Yourself

How did you hear about us:*
Other:
Salutation
First Name*
Last Name*
Address*
Address 2
City*
State*
Zip Code*
Country
Phone*
Work Phone
Home Phone
Mobile Phone
Fax
Best Time to Call:
E-mail*
Web Site
Would you like to receive updates and notices from Dean & Draper?

Business Information

SIC Code
Nature of Business
Years in Business

Current Plan Information

Do you currently offer Medical Coverage?
Current medical plan
Do you currently offer Dental Coverage?
If Yes to any of the above, who is your Current Medical Insurance
company, and how long?
If Yes to any of the above, who is your Current Dental Insurance
company, and how long?
Total Number of Employees:
Total Number of Eligible Employees:
Current Employer Contribution for Employees (%):
Current Employer Contribution for Dependants (%):

Medical Profile:
Answer the following questions to the best of your knowledge for all eligible employees and their dependants.

Has anyone been treated for a serious illness, been hospitalized,
or had surgery in the past 5 years?
Has anyone undergone open-heart surgery or
received significant cardiac testing at anytime in the past?
Has anyone had a claim of $10,000 or more in the past 12 months?
Is anyone apt to have a continuing claim due to a mental or physical disorder,
or for prescribed drugs?
Has anyone been advised to have surgery or diagnostic testing in
the last six months or anticipate hospitalization for any other reason?
Are any employees or dependants pregnant?
Has any employee missed 10 or more consecutive days
of work in the past 12 months due to illness or injury?
Are there any employees who are not actively at work performing
his or her full time duties?
Are there any current or former employees or dependants
currently on COBRA?
If you answered yes to any of the "Medical Profile" questions above,
please provide details below?
(Age, Nature of Disorder, Medication, & Current Prognosis)
Comments / Questions?

Subscribe to Groups

There currently aren't any fields under this section

Play Sound
© 2007 Dean & Draper
Home | About Dean & Draper | Contact | Site Map
Site Designed by True Light Resources
Content Management by Tendenci