Group Health Insurance
from 2 to 700 employees

GEMS Insurance can provide a plan that will take care of you and your employees.

If you would like to receive a quote for group health insurance, we invite you to complete the following form. Please fill in all fields applicable to your request. A comment area is provided at the bottom of the form for you to ask questions or clarify your inquiry. If your browser does not support forms, feel free to E-Mail us.

Note: We serve only California.

Contact Name

Business Name

DBA

Street Address

City   State   Zip

Phone Number
Best Time to Call   AM   PM

Fax   E-Mail

Current Carrier

Renewal Date

Number of Employees

Percent of Employees Covered

Dependent Coverage?   Yes   No

Currently We Have   HMO   Indemnity Plan   Self-Insured

Comments/Questions




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