Employee Benefits Quick Quote Form
Complete the form below and we'll send you a "quick quote" on the employee benefits that interest you. Questions? Email Eric Laughlin, Manager, Broker Services, Council Services Plus, at
ELaughlin@councilservicesplus.com
or call (800) 515-5012 x 128.
Primary Contact
First Name
Last Name
Title
Organization Name
Email Address
Phone Number
Your Organization
Are you a current NYCON member?
Yes
No
Not Sure
Address Line 1
Address Line 2
City
State
Zip Code
In what county is your nonprofit located?
Your Overall Benefits Needs
Our organization is interested in:
Dental Insurance
Health Insurance
Vision Insurance
Health Reimbursement and Flexible Spending Accounts (HRA/FSA)
Life Insurance
Disability Insurance
Our primary goal is to:
Save money over current plan(s)
Enhance benefits over current plan(s)
Save time on paperwork and administration
Start a new plan
Just looking, evaluating our options
Number of eligible employees:
How many employees would participate?
Dental Insurance
From what we have read, we are most likely interested in:
DeltaPPO Option (PPO)
DeltaCare USA Option (HMO)
Unsure
If you have a plan in place already, when does it renew?
Please upload your current plan's "benefits summary" and any rate information you may have for individuals, spouses and families. (It's helpful for us, but not a requirement)
Health Insurance
How many plan designs do you currently have?
One
Two
Three
More than three
Please upload your current plan's "benefits summary" and any rate information you may have for individuals, spouses and families. (It's helpful for us, but not a requirement)
Vision Insurance
If you have a plan in place already, when does it renew?
Please upload your current plan's "benefits summary" and any rate information you may have for individuals, spouses and families. (It's helpful for us, but not a requirement)
Life Insurance
If you have a plan in place already, when does it renew?
Please upload your current plan's "benefits summary" and any rate information you may have for individuals, spouses and families. (It's helpful for us, but not a requirement)
Disability Insurance
If you have a plan in place already, when does it renew?
Please upload your current plan's "benefits summary" and any rate information you may have for individuals, spouses and families. (It's helpful for us, but not a requirement)
Please let us know if there are any "must haves" you are looking for in your new employee benefits plans, or if there's anything else you'd like to tell us!
Contact Information