Utah Health Insurance - Affordable Term Life Coverage

Group Business Health Plans From Utah Health Insurance

Group Business Plans

Would you like to save thousands of dollars on your group health insurance plan? Let us help you. If you have more than 10 employees or prefer not to complete the information below you can fax your employee census to 801-568-1320, or you can email us at don@utahhealth.com If you have questions please call Don Murray at 801-518-4292, or Rae Miller at 801-879-9180. If your out of state please call us toll free at 1-866-587-5267.

Once we receive your census we will then prepare at least 3 quotes from fine companies such as IHC/Select health, BlueCross, Aetna and any others. Your package and program will be ready in 24hrs. We then can make an appointment to review all the programs that you wish to apply for. Remember we are a local company with real people to answer your questions. Thank you for using our service.

Name
Business Name
Address
City
ZIP Code
E-mail Address (Required)
Phone #
Best Time to Call
Send Quote Via	E-mail Phone
# of full-time Employees
Current Health Insurance	Yes No
If Yes, Current Carrier
Date of Expiration
How did you hear about us

Does anyone in your group have any Pre-existing medical conditions such as Cancer, Diabetes, Heart conditions, High Blood Pressure, Asthma etc.. If so, please explain below

Group Health Only

Group Life Only

Both

Individual, Family or Employee information

Name	Age	Gender	Coverage Type

Major Medical Deductible		Pregnancy Coverage
Dental Coverage		Prescription Card
Disability Coverage		Coverage Option

Group Life Insurance	Amount
	$

This request form is only a request for information on health insurance and does not bind, provide or guarantee any coverage.

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68 W Center St Midvale Utah, 84047

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