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Home > Health > Group Health Insurance Quote Request
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Group Health Insurance Quote Request


Please take a moment to fill out the form below and one of our representatives will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.

  • General Information
  • Type of Business
  • Current Group Health Insurance Information
  • Benefits Desired
Legal Name of Business *
First Name *
Last Name *
Street *
City *
State *
ZIP / Postal Code *
Business Phone *
Best Time To Call
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E-Mail Address *
Type of Business *
Number of Full Time Employees *
Number of Part Time Employees *
Give a complete description of any type of hazardous/dangerous duties performed by your employees *
Carrier (Company) Name (not agency) *
Policy Expiration Date
/ /
Premium Amount
Years Insured
Please give a brief description of your current Group Health plan
Major Medical Deductible *
Disability Insurance *

Group Life Insurance *

Dental Coverage *

Supplemental Accidental Coverage *

PPO Option *

HMO Option *

Additional Comments or Questions
Please send attachment to justin@stalwartinsurance.com
Employee Information
Please send census information to justin@stalwartinsurance.com
Submission Validation
Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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  Stalwart Insurance, LLC
2550 Boyce Plaza Rd #120
Pittsburgh, PA 15241 412-677-2312
Stalwart Insurance has assembled the finest, most experienced, and successful staff of benefits professionals whose practical knowledge is matched by their ethics and integrity. We further arm them with continuous education, training and cutting-edge technical resources. These highly specialized consultants have built a reputation for excellence, and a tenacious pursuit of dominant agency growth.
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