Am I Eligible?

To be eligible for online quoting the following must be true:

• The employer group must either have an active Department of Labor number or be in the process of obtaining one in order to receive a quote. Once you receive a quote, we will not be able to install your group into our system without an active Department of Labor on file.
• Must be a small group (1-50 Full Time Equivalent Employees Total Nationwide)

Registration

Please enter your information below. You will receive a confirmation email when you are approved. If we cannot process your registration, a sales representative or small group account manager will contact you by telephone or by e-mail.

If you have any questions please contact us

*  Indicates required fields

E-mail address* This email has access to other regions/states but not the current region/state(s).
To gain access fill out any editable fields below and submit the form.

First name*

Last name*

Create Your User ID*

Password*

Verify Password*

Phone*

User Type* Broker

Legal Business Name*

Doing Business As*

Agency Name*

Are you licensed in the state of Hawaii?* Yes No

Are you appointed with Kaiser Permanente Hawaii?* Yes No

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