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Group Health Insurance Census


  • In order to get an accurate comparison, please provide the following information:
  • (e.g. $500-$1000 or higher)
  • (e.g. 80%/20% plan)
  • (e.g. $20 - $30 per visit)
  • Name of EmployeeM/FE.E. Date of BirthEmployee AgeSpouse's Date of Birth (if applicable)**Spouse's Date of Birth (if applicable)**No. of children (ages not important)Residence Zip Code 


  • **Notes: If no spouse - indicate single or divorced - only if there are dependents
    E.E. = Employee
    If spouse has his/her own insurance, leave spouse details out.

Illinois Office

  • 95 N Research Dr
  • Suite 100
  • Edwardsville, IL 62025
  • Mon-Fri: 8am - 5pm
  • phone 618.692.9800
  • toll free 800.556.2663
  • fax 618.692.9865
Directions +

Missouri Office

  • 2236 Mason Ln.
  • Ballwin, MO 63021
  • Mon-Fri: 8am - 5pm
  • phone 314.821.6560
  • toll free 888.868.6560
  • fax 314.821.5779
Directions +