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Get Regence Quote Request Form
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How to fill out the Regence Quote Request Form online
This guide provides a step-by-step approach to completing the Regence Quote Request Form online. Whether you are seeking coverage for medical or dental services, this comprehensive overview will help ensure you fill out the form correctly and efficiently.
Follow the steps to complete your quote request form
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering your preferred effective date for coverage in the designated field. Use the mm/dd/yyyy format for clarity.
- Provide your company’s address including the street address, city, state, county, and ZIP code to ensure accurate communication.
- Fill in the primary contact information, including the contact person's name, phone number, fax number, and email address.
- Indicate whether there are employees based in other states not listed in the form.
- Complete the section regarding the percentage of premiums your company will pay for employee and dependent medical and dental coverage.
- If applicable, disclose any affiliations with other companies and provide the name of the current carrier for medical and dental coverage.
- If Regence is your current carrier, include your group number and then provide details for your producer, if you have one.
- List the employees who will be covered under the policy. Include their names, dates of birth or ages, and specify if a spouse will be covered.
- For any additional employees beyond ten, attach separate sheets detailing their information.
- Review all entered information for accuracy and completeness before proceeding.
- Once satisfied with the form, you can save changes, download, print, or share the completed form as necessary.
Complete your Regence Quote Request Form online today for prompt assistance!
You can reach RGA customer service at 1-800-234-1234. The service representatives are available to assist you with any questions related to your health plan. For a more detailed exploration of your options, the Regence Quote Request Form can also provide helpful guidance.
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