ONLINE QUOTE FORM

For premium and benefit information specific to your company, simply complete the fields below.  We will respond to you as soon as possible (usually by the next business day).

If you would like to schedule an appointment, please contact us at:

Phone: (508) 318-5594
Fax: (617) 507-6215
Email:
matt@cooneyhealth.com
Cooney Health :: Group Health Insurance

Employer Information

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Employee 1
Name: Sex M F Date of Birth
Coverage Type: Salary Status
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Employee 2
Name: Sex M F Date of Birth
Coverage Type: Salary Status
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Name: Sex M F Date of Birth
Coverage Type: Salary Status
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Employee 4
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Coverage Type: Salary Status
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Coverage Type: Salary Status
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Coverage Type: Salary Status
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Coverage Type: Salary Status
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Name: Sex M F Date of Birth
Coverage Type: Salary Status
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Employee 10
Name: Sex M F Date of Birth
Coverage Type: Salary Status
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Name: Sex M F Date of Birth
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Name: Sex M F Date of Birth
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Name: Sex M F Date of Birth
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Coverage Type: Salary Status
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Name: Sex M F Date of Birth
Coverage Type: Salary Status
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Name: Sex M F Date of Birth
Coverage Type: Salary Status
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