Benefits Info Sheet

    1. Personal Info **Please complete all fields**

    2. Available Plans **If you would like more information or enroll, please check the appropriate box below**


    Employee & Spouse

    1 Parent Family

    Family Plan

    Disability quoted individually only - based on salary and other criteria. *Guaranteed issue policies

    3. How It Works

    Pays CASH benefits directly to you, not the provider (doctor/hospital). Benefits can be used to pay co-pays, deductibles & other out of pocket medical expenses. Benefits are designed to pay everyday living expenses (i.e. rent/mortgage, car payment, groceries, utilities, etc.)

    Plans are GUARANTEED renewable, meaning we will never cancel on you.

    Policies are PORTABLE! Even if you change jobs, you can take it with you.


    First Name

    Last Name

    Date of Birth


    Protect You Finances Plan For The Unexpected