PattersonInsure.com

Patterson and Associates Employee Benefit Solutions
Coverage for the whole family
Home Group Health Insurance Group Dental Insurance Individual Health Insurance Term Life Insurance AFLAC



Ph: 330-562-0898
Fax: 330-562-0899

1151 Winchell Rd.
Aurora, OH. 44202




Testimonials

I purchased a new HSA plan on-line through Patterson & Associates. What a great way to buy health insurance.
Rob S. - Kent, Ohio


Shopping on-line for my insurance coverage was quick and easy! Great rates, Excellent coverage.
Jeff H. - Seville, Ohio




Interactive Links
Drugstore.com
WebMD
Life-Line.org
Glossary of Insurance Terms

Group Health Insurance Quote Request

Please take a moment to fill out the form below and one of our representatives will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.


General Information
Legal Name of Business:
Contact Name:
Address:
City:
State:     Zip:
Business Phone:   Fax:
Best Time To Call:   AM   PM
E-mail Address:

Type of Business
Type of Business:
No. of Full Time Employees:         No. of Part Time Employees:
Give a complete description of any type of hazardous/dangerous duties performed by your employees:

Current Group Health Insurance Information
Carrier (Company) Name (not agency):
Policy Expiration Date:   Premium Amount: $
Years Insured:
Please give a brief description of your current Group Health plan:

Benefits Desired
Major Medical
Deductible: 		Optional
Pregnancy Coverage: 		Yes
No
Dental Coverage: Yes
No		 Supplemental
Accident Coverage: 		Yes
No
Disability Insurance: Yes
No		 PCS Card:
(Prescription Disc Option) 		Yes
No
Group Life Insurance:
 Yes
No		 PPO Option: Yes
No
Amount: $ HMO Option: Yes
No

Employee Information
Please list all employees you wish to cover:
Employee Name Date of Birth Zip Code Sex Dependent Status
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
Male
Fem
If you were not able to list all employees you wish to cover in the spaces above, please use the Additional Comments section below or indicate that you will fax or e-mail an additional listing.


Additional Comments or Questions

Please click the "Submit Quote" button to send your quote request. No coverage is in effect until bound by an insurance carrier. This is a request for quotation only.




James Patterson is a licensed agent in Ohio and Michigan.
Please contact our webmaster for questions regarding this website.

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