Allegis Advisor Group (800) 418-1788
10235 South Jordan Gateway, Suite 100, South Jordan, UT 84095
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AAG-190213-Group Coverage Fact Finder-v1
What date would you like new coverage eective?
Advisor Name Advisor Email Advisor Phone
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1. Advisor Info
2. Employer Info
3. Existing Group Coverage
If existing coverage is present please provide copies of: current plan design, current employer census and current invoice for coverage.
4. Unless otherwise indicated, we will quote the following
5. Please leave any special instructions, questions or comments here
Group Coverage Fact Finder
Life: employer-paid voluntary
Short-term Disability: employer-paid voluntary
Long-term Disability: employer-paid voluntary
Vision: employer-paid voluntary
Dental: employer-paid voluntary
• Life employer-paid – $50,000 benefit amt
• Voluntary Life
• Short-term Disability – 14/14 elimination period, 90-day benefit period
a) Employer-paid – 60% benefit, maximum weekly $1,500
b) Voluntary – 90-day elimination period
• Long-term disability – 60% benefit, maximum monthly $6,000
a) Employer-paid
b) Voluntary
• Vision
a) Employer-paid
b) Voluntary
• Dental
a) Employer-paid
b) Voluntary
Please include a completed Allegis Census Form with all quote requests.
Email bart.spencer@allegisag.com and rob.c@allegisag.com for more information
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