BeniComp QuickQuote

Welcome! BeniComp makes it easy for brokers and employer groups to quickly quote a revolutionary self-insurance product! Simply fill out the form below and we'll take it from here.

Broker Name Broker Name First Last
Broker Email Address
Employer Group Name
Number of Eligible Employees
Must be a number between 25 and 100
In order to provide better rates please enter your SIC Code below. If you don't know it, you can quickly look up your SIC code here.
SIC Code
Employer Group Primary Location Employer Group Primary Location
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Plan Effective Date Plan Effective Date / MM / DD YYYY
Download Sample Census

To complete the quote you must provide a census in the following format and upload it using the field below.
Census Upload

Attach Files

It is required that you download and use the census template found above.
Upload Additional Files

Attach Files

If you have any other files you would like to share to assist with the quoting process then upload them here.

BeniComp QuickQuote

BeniComp QuickQuote

Download Sample Census