Complete form &
Group Health Plans
Made Simple.

Emerald Coast businesses may be able to reel in their health plan costs.
Small businesses on the Emerald Coast now have exciting new ways to hook some impressive health insurance savings. Plans from UnitedHealthcare include a broad local network, strong national support and surprisingly low rates. To see how much your business could save, call your broker today.
Simply complete the form below and a UnitedHealthcare representative will contact you.
*Required Field

First Name*

Last Name*

Company Name*

Company Address*




Phone* (xxx-xxx-xxxx)

Email Address*

Number of Employees*                 

Number of Insured Employees

Renewal Date (xx/xx/xxxx)                          

I am the health insurance:

Indicate your Interest:
(Check all that apply)






I would like to discuss a quote in the next few days:

Current medical benefit carrier

Do you work with a broker?

If yes, what is the Broker's name?
What is the Agency's name?

Additional Information
(Character limit 255)

UnitedHealthcare policies may have exclusions or limitations or terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact your broker, consultant or UnitedHealthcare Representative.
Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Health Plan coverage provided by or through UnitedHealthcare of Florida, Inc.