Benefit Services Logo - Group and Individual Insurance, HSA, HRA. We help cut your insurance premiums.
Phone: (248) 553-9040
 info@benefitservicesgroup.com
 
Home > Voluntary Benefits
Home
About Us
Ask The Benefit Brain!
Services
Client Access
Quotes
Newsletter
Knowlage Library
Appointment
Free Seminars
Subscribe to our newsletter
 We discuss pertinent subjects relating to financial and insurance related topics that could benefit you, your employee's and your company.
H.R. University
Free Seminars RSVP Today!

 
Voluntary Benefits

[Quote Home] [ Medical Quote ]
[ Medical Guaranteed Acceptance ] [ Short Term Medical ] [ Student Select Medical ] [ Voluntary Benefits ] [ 24 Hour Accident ]
 

Assurant VoluntaryMart Benefits Brochure*

Please Check The Products Elected: Proposed Effective Date:
Accident Policy
Cancer Policy
STD Policy
Dental Policy
Life Policy
Hospital Confinement Sickness Indemnity Policy
Hospital Indemnity Policy
Heart/Stroke Indemnity Police
Applicant Information: Include Spouse Information
Group box Yes    No
Birthday:                     Birthday:         
Height:  Feet          Inches Height:  Feet          Inches
Weight:  Lbs. Weight:  Lbs.
Tobacco or Nicotine User in past 12 months:   Tobacco or Nicotine User in past 12 months:  
Annual Salary:   Annual Salary:  
Application State (where Signed):  MI
State of Residence:  MI
Zip Code:  
Job Industry:  
Job Category:  
Billing Mode:  
Contact Info:  
First Name:   Last Name:  
Company:    
Title:    
Address:    
Address 2:    
City:    
Phone:   Fax:  
E-mail:  
Subscribe to Newsletter?

     

*
Privacy Statement
Copyright 2008, Benefit Services Group, Inc.   Home | About Us | Ask The Benefit Brain! | Services | Client Access | Quotes | Newsletter | Knowlage Library | Appointment | Free Seminars