Healthcare benefits the way they should be Company Name (Your info will never be shared or put into automated messaging systems.) Name First Name Last Name Email address you want the quotes delivered to Phone (###) ### #### How many employees will be on the plan as “employee only” (no spouse or children) How many employees will be on the plan as “employee + spouse” (no children) How many employees will be on the plan as "employee + child(ren)"? How many employees will be on the plan as “employee + family” (employee, spouse, children) Thank you!