Request A Quote

CEBA will be happy to have one of our benefit advisors contact you to determine your group or individual insurance needs.  Just fill out and submit the Information Request Form at the bottom of this page.  Or, if you are an individual seeking insurance for yourself or your family, you can get quotes directly from insurance companies by using the self-service section below.

Self-service:  If you need individual health or short term medical insurance, you can get online quotes and apply online directly with any of the well-known insurance companies you see here.  You can always call us with any questions you may have regarding the quotes, benefits, companies, or how to apply.

Short Term Medical	Short Term Medical
Individual Health	Individual Health

Individual Health	Individual Health	Individual Health

If you would like to receive an individual or family health plan quote from Blue Cross Blue Shield, please contact us directly and we will be happy to assist you.

Let us help you: If you are an employer seeking assistance on your group benefits program, or if you are a Medicare eligible individual or <65 individual who would like us to help you with your insurance needs, please fill out and submit the Information Request Form below.  One of our benefit advisors will contact you shortly to determine how we can assist you.

Information Request Form

*	= Required Field
*	First & Last Name
	Date of Birth	(MM/DD/YYYY)
	Street Address
	City	State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY     Zip Code
*	Phone Number
*	Email Address
	Company Name
	Title / Position
	Number of Employees
	Type of Business
	What are you interested in?	(select all that apply)
	Individuals Only:	Health Dental Life Disability Medicare Part D Medicare Supplemental
	Group Only:	Health Dental Life Disability Supplemental Retirement
	How did you hear about CEBA?
	Additional Comments / Questions