Business Information

Business Name:

Premises Address:

City:

State:

Zip Code:

Years In Business:

Contact Name:

Phone:

Extension #:


Email:  (Required)


How Best To Contact You:
Select One Phone Email

Federal Employer's ID #:

Description of Operations:


Any Employees Currently Insured:
Select One Yes No



Coverage Information

Who Will Be Insured:
Select One All Employees Some Employees Management Only Owners Only

Number of Employees to be Insured:
Select One 1 to 5 6 to 20 21 to 50 51 to 100 More Than 100



Choose Coverage and Limits

HMO Group Health Insurance

HMO Co-Pay Amount Desired:
Select One None $15 $20 $30


PPO Group Health Insurance

PPO Deductible Amount Desired:
Select One None $250 $500 $1,000


POS Group Health Insurance

POS Co-Pay Amount Desired:
Select One None $15 $20 $30


Major Medical Health Insurance

Major Medical Deductible Desired:
Select One None $250 $500 $1,000



Choose Additional Benefit Options

Dental Insurance

Vision Insurance

Life Insurance



Any employee to be insured
had health problems during the
past 18 months?
Select One Yes No


If Yes, list employee(s) information:





Question or Message:



Click the "Submit Quote Request"
button below to send your New York
Group Health Insurance request to
Direct Access Group Benefits.


***By submitting this request you
acknowledge that this is neither
an offer to insure nor a guarantee
of insurance.***

We are a Somers, NY insurance
agency offering New York group
health insurance quotes in the
following towns, cities and counties
in the Westchester County, NY area:
Port Chester, Harrison, Mamaroneck,
Larchmont, New Rochelle, Yonkers,
White Plains, Rye Brook, Scarsdale,
Rye, Ardsley, Hartsdale, Bronxville,
Mount Vernon, Irvington, Valhalla,
Elmsford, Dobbs Ferry, Hastings
on Hudson, Greenburgh, Tarrytown,
Sleepy Hollow, Hawthorne,
Scarborough, Thornwood, Briarcliff
Manor, Ossining, Harmon, Montrose
Crugers, Buchanan, Peekskill, Millwood,
Pleasantville Armonk, Chappaqua, North
Castle, Mt. Kisco, Bedford, Pound Ridge,
Bedford Hills, Cross River, South Salem,
Yorktown Heights, Goldens Bridge,
Amawalk, Yorktown, Katonah, Salem
Center, Somers, North Salem, Croton
Falls, Jefferson Valley, Shrub Oak,
Palisades, Sparkill, Tappan, Orangeburg,
Pearl River, West Nyack, New City,
Nanuet, Chestnut Ridge, Montebello,
Suffern, Monsey, Spring Valley, Congers,
Nyack, Rockland Lake, Wesley Hills,
New Hempstead, Pomona, Sloatsburg,
Ramapo, Hilburn, Willow Grove, Mt. Ivy,
Thiells, Tomkins Cove, Ladentown,
Haverstraw, Stony Point, Tomkins Cove,
West Haverstraw, Bear Mountain, Jones
Point, Newburgh, Middletown, Bronx,
New York City, Brewster, Poughkeepsie,
Putnam County, Orange County, and
Rockland County, NY.



Direct Access Group Benefits, Inc.
189 Route 100, PO Box 590
Somers, NY 10589
Westchester County, New York

Group Health Insurance Quote Westchester County, NY Somers, New York Area

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