Kilpatrick

Quote Requests

To request a quote from our office, download the appropriate form below and complete. If you choose to use your own forms, please review ours to verify that your information is complete. Doing so will help reduce quote turnaround times and potential for errors. A group’s market segment is determined by the average total number of employees employed in the calendar year prior to the effective/anniversary date. This number is critical for quoting purposes.

Group Benefits

FileCommentsUpdated
Census TemplateAll group sizes. Use the Census and Group Information sheets. Required RFP data varies by market segment. Workbook includes an ATNE calculator.2019-04
Claim RequestsEach carrier has their own process.
Large Group RFPUse for fully insured large groups as a substitute to collect group info when our census template is not used. If you provide the census in our template, use the group information sheet in that workbook instead.2018-08
Self-Funded Medical ChecklistUse for groups that have a current self-funded medical plan. Includes a claim request checklist for medical, dental, and vision.2016-08
Large Group Data RequirementsDetailed checklist of required data elements required to quote very large groups. Covers all lines of coverage specific to group size. Not applicable to smaller groups.2016-08
Payroll and HR FormData collection to request quotes for payroll and HR outsourcing services.2011-12

Occupational Accident and Workers Comp

FileCommentsUpdated
Non-SubscriptionOne page form required to quote occupational accident options.2010-02
Workers CompensationApplication and request form for workers comp quotes.2013-09