Large Group Quote Questionnaire 2026

1. Click ‘Get Form’ to open the Large Group Quote Questionnaire in the editor.
2. Begin by filling out the Agent Information section. Enter your name, agency, and contact details including fax and email.
3. Next, move to the Employer Information section. Provide the employer/group name, industry type or SIC code, contact person’s details, and location information.
4. Complete the Required Paperwork checklist by ensuring you have all necessary documents ready for submission. This includes a completed census and claims reports.
5. Fill in the Current Carriers section with details about your current insurance provider and renewal date.
6. In the Rates section, input current premiums for different coverage types such as Single, Family, etc., along with employer contribution percentages.
7. Provide billing information if it differs from above and specify the requested effective date and deductible amount.
8. Select your preferred tier structure and complete employee-related fields regarding eligibility and coverage waivers.
9. Finally, review available riders and additional services before submitting your completed questionnaire.

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