Group Health Insurance Colorado - Coverage Quote

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How many employees to insure?

*Do you have employees in other locations?

If Yes, where?

*Please enter a census of all current, full-time employees.

Be sure to include EACH EMPLOYEE'S age and dependent status.

• EE = Employee ONLY
• ES = Employee + Spouse
• EC = Employee + Child(ren)
• F = Entire Family

Name (or Sex), Age, Family Status (EE, ES, EC, or F)