simplicty, service, savings

Services: Employer: Request A Quote

Employer Quote Request Disclaimer: If you currently are working with an insurance agent or benefit consultant, please contact them in regards to obtaining a quote.

If you do not have or are not working with an agent/consultant and wish to obtain a quote through Association Benefits Company, please fill in the form below.We will contact you within 1-2 business days.

Company Name
Type of Business
First Name Last Name
Address
City State Zip Code
Phone FAX
Email

Replace Existing Coverage? Yes No

Choose your company's contribution level:

You may upload your company census, or create one below.

Upload Census:
Number of Enrolling Employees:     Number of Eligible Employees: 
  Employee Information
  Name or Initials BirthDate Age as of
Eff Date		 Contract Type Gender  
1 -OR- Delete
Add More Employee(s)  
Association Benefits Company • Copyright © 2007 • 24600 Northwestern Highway, Southfield, MI 48075
Phone: (248) 356-3366 . (800) 782-0712 . Fax: (248) 356-8589
An authorized Blue Cross ® Blue Shield ® of Michigan administrator. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.