Home
Contact Us
Staff Directory
Directions
About AFG
OMNIA Health Alliance
Benefit Summaries
Horizon Forms Library
Doctor and Hospital Finder
Horizon Carrier Contacts
Life & Disability Insurance
Commissions & Bonuses
Submission Deadlines
Contracting with AFG
AFG Newsletters
Webinars & Presentations
AgencySmart
Medicare
Quoting
Horizon Portal / Registration Link
The Consolidated Appropriations Act, 2021 (CAA) Section 204-Reporting on Pharmacy Benefits and Drug Costs
Horizon Broker Brief
Horizon Grandmothering Extended Into 2023 for Pre-ACA Plans
Horizon Broker Brief
Horizon to Withdraw HMO Plans from Individual and Small Employer Markets
Horizon Broker Brief
Request a Free Quote
General Information
Agency name:
Agent name:
Business name:
Street address:
Zip code:
Phone:
Fax:
I would like to request a quote for:
Health
Dental
Plan Design
Current Plan
Desired Plan
Insurance provider:
Aetna
AmeriHealth
Horizon BCBSNJ
Oxford
Other:
Aetna
AmeriHealth
Horizon BCBSNJ
Oxford
Plan type:
None
HMO
PPO
POS
Open Access
Other
HMO
PPO
POS
Open Access
Office co-payment:
None
$5
$10
$15
$20
$30
Other
None
$5
$10
$15
$20
$30
Other
Deductible:
None
$250
$500
$1000
Other
None
$250
$500
$1000
Other
Co-Insurance:
None
100/80
100/70
100/90/70
Other
None
100/80
100/70
100/90/70
Other
Prescription (Rx):
None
$5/$10
$10/$15
$15
Other
None
$5/$10
$10/$15
$15
Other
Comments:
Company Census
Employee Name
Gender
Status
Birth Date
1:
Male
Female
Single
Husband/Wife
Parent/Child
Family
Waived
2:
Male
Female
Single
Husband/Wife
Parent/Child
Family
Waived
3:
Male
Female
Single
Husband/Wife
Parent/Child
Family
Waived
4:
Male
Female
Single
Husband/Wife
Parent/Child
Family
Waived
5:
Male
Female
Single
Husband/Wife
Parent/Child
Family
Waived
