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
Horizon is Making Changes to its Level Select Platform of Products
Horizon Broker Brief
Remember to Use Horizon's Member Maintenance Portal
Horizon Broker Brief
HorizonbFit Incentive Program to Sunset for Individual and Small Group Members
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
