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Get a quote for captive insurance in 3 easy steps!

  1. Enter your contact information and basic information about the Employer
  2. Upload documents
  3. Schedule a discovery call

Securely submit information to help with plan design

Please submit supporting documentation so that we may assess your current health plan and needs. All documents are submitted this secure connection and are CONFIDENTIAL. No information submitted will be used for any purpose other than helping to identify a captive program that works for your needs.

Required documents:

  • Dependent Level Census: First name, last name, zip code, relationship, coverage level, medical plan choice
  • Minimum of 50 lives
  • Current Plan Designs: Summary Plan Description (SPD) preferred
  • Current Rates

Optional documents if available:

  • Renewal info
  • 12 Months of Claims history (if available)


Step 2: Upload support documents