Contact Us

Refer A Friend!

Know someone who is ready to upgrade their insurance agency and benefits experience? Refer a friend!

Submit A Claim

Bypass calling our office and fill out your insurance claim service request online! Simply fill out the form below, include as much information as possible, and a member of our claims team will begin to resolve your issues upon receiving the form. We look forward to working with you very soon.

Your full name (as it appears on your I.D.) *

Phone *

Email (to receive updates on your ticket) *

Date of Birth (MM/DD/YYYY) *

Your Employer *

Please describe the assistance you need. (Include as many details as possible for us to serve you better) *

Is this claim for an upcoming surgery or urgent medication? *

Surgery/Authorization

Medication

Please disclose the below details on your surgery *

Please disclose the below details on your medication needs: *

Submit all relevant claim documentation here:

Please note: If you are taking photos of documentation with your phone, please lay the document on a flat surface, make sure the area is well lit and the photo is taken from straight on, not at an angle..

Please also make sure that the document is clear and legible.

Maximum upload size: 268.44MB

If you are human, leave this field blank.

Employee Adjustment/Termination Form

Prior to filling out this form, please note:

If you are an individual making changes to your plan, you MUST also notify your employer. We will not be able to proceed unless your employer is also notified of the changes.

I understand

Company Name *

Employee Name (Full Name As It Appears On Your I.D.) *

Email Address *

Employee DOB *

Termination Date *

Dependent Coverage

Spouse

Child

Dependent Name:

Dependent DOB:

All Lines of Coverage

Employee Only

Dependent

Medical

Employee Only

Dependent

Gap

Employee Only

Dependent

Vision

Employee Only

Dependent

Dental

Employee Only

Dependent

STD

Employee Only

Dependent

LTD

Employee Only

Dependent

Life

Employee Only

Dependent

AD&D

Employee Only

Dependent

If you are human, leave this field blank.

Employee Enrollment Form

Prior to filling out this form, please note:

If you are an individual making changes to your plan, you MUST also notify your employer. We will not be able to proceed unless your employer is also notified of the changes.

I understand

Company Name *

Employee Name (Full Name As It Appears On Your I.D.) *

Employee Contact Phone Number *

Email Address *

Gross Income

Occupation

Employee DOB *

Social Security NO. *

Gender *

Male

Female

Address *

City *

State *

Zip Code *

All Lines of Coverage

Medical

Gap

Vision

Dental

STD

LTD

Life

AD&D

Primary Care Physician Full Name: (phone number) Facilities cannot be assigned

Do you have a dependent to add?

Yes

No, I'm finished.

> Dependent Coverage

Spouse

Child

Dependent Name

Dependent DOB

Social Security No.

Gender

Male

Female

All Lines of Coverage

Medical

Gap

Vision

Dental

STD

LTD

Life

AD&D

Primary Care Physician Full Name: (phone number) Facilities cannot be assigned

Do you have a second dependent to add?

Yes

No, I'm finished

> Dependent Coverage

Child

Dependent Name

Dependent DOB

Social Security NO.

Gender

Male

Female

All Lines of Coverage

Medical

Gap

Vision

Dental

STD

LTD

Life

AD&D

Primary Care Physician Full Name: (phone number) Facilities cannot be assigned

Do you have a third dependent to add?

Yes

No, I'm finished

> Dependent Coverage

Child

Dependent Name

Dependent DOB

Social Security NO.

Gender

Male

Female

All Lines of Coverage

Medical

Gap

Vision

Dental

STD

LTD

Life

AD&D

Primary Care Physician Full Name: (phone number) Facilities cannot be assigned

**Primary care physicians only required if coverage is through Neighborhood Health and BCBS**

If you are human, leave this field blank.

Submit A Service Request

Bypass calling our office and fill out your insurance service request online! Simply fill out the form below, include as much information as possible, and a member of our service team will work on your service request upon receiving the form. You will have an update on your service request within 24-48 hours. We look forward to working with you very soon.

Types of service requests include: incorrect invoice, request a new ID card, request help finding a provider, etc.

Your full name (as it appears on your I.D.) *

What is the company you work for? *

Your Phone: *

Your Email: *

Please describe your service request: *

If you are human, leave this field blank.

Request for Information

Whether you are interested in providing your employees benefits, or want to make sure you aren’t overpaying for your current group insurance, allow us to answer any questions you may. Our team looks forward to working with you!.

NAME *

PHONE *

EMAIL *

WHAT SERVICES ARE YOU INTERESED IN FOR YOUR COMPANY?

Health Insurance (Medical, Dental, Vision)

Disability Policies

Life Insurance

Group Retirement

Business Consulting Services

HR Services

Payroll Services

Workers' Compensation

Financial Designs Wealth - Financial Services

All of the above

I AM LOOKING TO OFFER HEALTH INSURANCE FOR A GROUP OF 10 PEOPLE OR MORE *

YES

ANY ADDITIONAL INFORMATION FOR US? *

If you are human, leave this field blank.

Blue Cross Blue Shield
Smart Tools

BCBS Website
App Store (iOS)
Google Play (Android)

United Healthcare
Smart Tools
English Website
Website en Español
App Store (iOS)
Google Play (Android)

Aetna
Smart Tools
Aetna Website
App Store (iOS)
Google Play (Android)

Humana
Smart Tools

English Website
Website en Español
App Store (iOS)
Google Play (Android)

How can we assist you?

Have Questions
Or Comments?

Submit A Claim

Employee Adjustment/Termination Form

Employee Enrollment Form

Submit A Service Request

Request for Information

Contact Us

How can we assist you?

Have Questions Or Comments?

Have Questions
Or Comments?