Looking for Group Health Insurance?

Complete the form below to receive customized group health plan options within 24–48 business hours — at no cost or obligation.

Group Health Insurance Quote Form

Contact Info & Consent

Business Name *

Contact Name *

Email *

Phone *

State *

(helps route based on state + carrier availability)

Postal Code *

By submitting this form, I agree that Fortune Shield Insurance Services and its licensed agents may contact me by phone, email, or text message to discuss group health insurance options.
I understand that my consent is not required to make a purchase, and message/data rates may apply.
My information will only be used to prepare quotes and plan recommendations.

Group Basics

How many full-time employees need coverage? *

How many part-time/1099s?

Target Start/Renewal Date

Current Benefits

Do you currently offer benefits? *

Health

Dental

Vision

Life

Short-Term / Long-Term Disability

None

Current employer contribution

Coverage Needs & Priorities

What’s most important to your business? *

Affordable rates

Attracting/retaining employees

Comprehensive coverage

Flexibility for part-timers

Are you interested in exploring alternative or level-funded plans?

Yes

Unsure

Next Steps

Census upload optional

Optional (Excel/CSV) - please remove any Social Security Numbers or private medical details

Add-ons you’re open to exploring:

Dental

Vision

Life

Accident

Disability

None

Fortune Shield Insurance Agency is a licensed independent insurance agency. Not all products are available in all states. Eligibility and benefits vary by carrier and state. Information provided is for quoting and educational purposes only.

Call +1 801-997-8196

Email: [email protected]

Site: www.FortuneShield.com

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