Our Health Insurance Carriers

• Aetna
• Assurant
Blue Cross/Blue Shield of AZ
• Cigna
• CSA (Dental)
• Delta Dental
• EDS (Dental)
• Metlife
• Securecare Dental
• United Healthcare
• VSP (Vision)

Group Health Insurance Application

Pritchard Group Insurance makes shopping for Group Health Insurance easy. Fill out our short, easy form and we'll shop for those companies who will compete for your business and find you the best deal. Get started now.
Business Name: *
Business Street Address: *
City / State / ZIP: *
Business Phone (please include area code): *
Cell Phone: *
FAX: *
Email: *
Type of Organization (LLC, Inc., Sole Prop, Nonprofit): *
Number of Eligible Employees:
Number of Employees Enrolling:
Effective Date:
Current Insurance Carrier:
Renewal Date:
Type of Plan (HMO, PPO, etc):
Premium $:
Deductible $:
Reason for Changing Carriers:
Known Major Medical Conditions:

Please send me a quote based on the information I have provided in this on-line application form.