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Get a Quote

Request for Proposals are made easy with our online quote submission process. Please fill out the information entirely and hit submit and the proposal request will be sent directly to Johnson Benefit Planning.

Please fill out the entire census form to receive the most accurate quote.

Final rates are determined by final enrollment. Changes in enrollment from the quote will result in rate adjustment

  • Group Information

  • Request For Proposal

  • Current Coverage

  • Census Form

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    Use the button at the far right to add new rows.



    Employee Name (Optional)Birth DateGender (M/F)Active / Waiving / Cobra / Declining / Ineligible / Probation (A/W/C/D/I/P)Tobacco (Y/N)Zip CodeSpouse (Y/N/DOB)Children (#)Child 1 DOBChild 2 DOBChild 3 DOBChild 4 DOBChild 5 DOBChild 6 DOBChild 7 DOBChild 8 DOBChild 9 DOBChild 10 DOB 
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