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employer quote form

instructions & notes:

1) Insert information on each Employee and his/her family. If you do not wish to include all employees, then provide information on those currently participating in any current medical coverage at minimum.

2) Please provide the Dates of Birth or Ages of each employee and covered dependent.

3) For Estimated 2015 Household Earnings, you may not know that employee's Household Earnings because that is usually private information, unknown to many employers. If so, please provide an estimate based only on the wages that the employee may earn from his/her employment at your organization.

*If left blank, household income will be assumed as 1.5X of the employee's total income, if the employee's spouse is marked as working.

Group Coverage Quote

Do you currently offer group coverage?

Yes No

Yes/No. If you do offer group coverage what do you contribute for Employee Only, Employee/Child, Employee/Spouse, Family?

Please add each employee's information below. With this information we will develop a cost benefit analysis to determine if the individual market, shop exchange, or group market is the best route for your employees. If you would prefer to send this information via excel, add your information and request a census in the notes and one of our representatives will email a census you right away.

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introducing the
AMERICAN EXCHANGE

PERSONAL
HEALTH ACCOUNT

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The American Exchange Personal Health Account, PHA, offers a stress free way to offer your employees health benefits. All while saving you money.

HOW THE PROCESS WORKS:

WHY THE PHA WORKS

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FIXED COST

The Employer is no longer left wondering “How bad will my renewal be this year?”Contributions to the PHA are Fixed and controlled directly by the business, not the insurance carrier.

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PROMOTE CONSUMER
DRIVEN HEALTHCARE

The trend in consumer driven health care has been growing at an increasing rate. The terms HSA and HDHP are more than common today.The PHA takes that one step further. Now the consumer has to choose what they need, with the help of a licensed, experienced agent to answer their questions.

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ATTRACT AND RETAIN

With the continuously decreasing participation rates in small group health plans, how many employees feel that the plan design ACTUALLY fits their needs?The PHA benefits all the employees in one way or another, and is a great benefit to offer employees.

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NO FEE ENROLLMENT SERVICE

We sit down with each of your employees and help them customize the BEST health plan, AT NO COST, for their unique life situation. Since each employee gets personalized service, they benefit from more options and are assured of finding the best possible match for their needs.

We are passionate about giving employers like you the freedom and flexibility to offer your employees many healthcare options without the administrative burden.

WE DO ALL THE WORK

WE SIMPLIFIED THE PROCESS

WE MAKE THE CHANGES WORK IN YOUR FAVOR

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Start by calling us. We’re here for you, from start to finish.

Give Us a Call
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