MDS Insurance Services, Inc.

					EDIA \| EDFS \| EDIC \| Links \| FAQs

Home | About MDSIS | Products | News & Seminars | Contact Us

Telephone: 800.821.6033

Get A Quote!

Signup to request a quote for an insurance benefit plan. There is no cost, enrollment, or obligation when obtaining a quote.

Sign Up Now

Mass Division of Insurance Rate Cap -Update 5/14/2010

If the health insurance situation wasn't confusing enough, the rate cap issue battle going on between the insurance carriers and the Mass Division of Insurance will surely send everyone over the edge. The April, May and June 2010 health insurance rate issue for companies with less than 50 enrolled employees has not been settled. Click below to learn more about what this means for your business.

Learn More

COBRA Subsidy Extended Update 4/21/2010

On April 15, 2010, the President signed into law an extension of unemployment benefits and the COBRA premium assistance that helps with the cost of health benefits for those that have lost their job. The new law also provides retroactive elgibility for individuals who lost their jobs after the prior COBRA subsidy expired on March 31, 2010.

Learn More

Get a Quote

Please complete the following form to request a quote for an insurance benefit plan. Upon receipt of this form, MDSIS-Spring will contact you within 24 hours to discuss your quote. There is no cost, enrollment, or obligation when obtaining a quote. All information received by MDSIS-Spring is strictly confidential.

Please Complete Company Information

Company Name

Contact Person

Business Address

City

State

Zip Code

Email Address

Business Telephone No.

Fax No.

Number of Eligibles to Enroll

Desired Effective Date

Currently Offering Insurance?
Yes
No

If Yes, what Plan?

Coverage Provided Through:

Complete for all Eligible Employees. Note: Salary and Position information is required ONLY when requesting Short-Term Disability, Long-Term Disability, or Life Insurance.
First Name: Last Name: Home Zipcode:	Gender: M F Smoker? Yes No	Type of Plan: Individual Family Waiving Coverage If Waiving, State Reason:	Date of Birth: Salary (see note):	Weekly Work Hours: Position (see note):

First Name: Last Name: Home Zipcode:	Gender: M F Smoker? Yes No	Type of Plan: Individual Family Waiving Coverage If Waiving, State Reason:	Date of Birth: Salary (see note):	Weekly Work Hours: Position (see note):

First Name: Last Name: Home Zipcode:	Gender: M F Smoker? Yes No	Type of Plan: Individual Family Waiving Coverage If Waiving, State Reason:	Date of Birth: Salary (see note):	Weekly Work Hours: Position (see note):

First Name: Last Name: Home Zipcode:	Gender: M F Smoker? Yes No	Type of Plan: Individual Family Waiving Coverage If Waiving, State Reason:	Date of Birth: Salary (see note):	Weekly Work Hours: Position (see note):

First Name: Last Name: Home Zipcode:	Gender: M F Smoker? Yes No	Type of Plan: Individual Family Waiving Coverage If Waiving, State Reason:	Date of Birth: Salary (see note):	Weekly Work Hours: Position (see note):

First Name: Last Name: Home Zipcode:	Gender: M F Smoker? Yes No	Type of Plan: Individual Family Waiving Coverage If Waiving, State Reason:	Date of Birth: Salary (see note):	Weekly Work Hours: Position (see note):

First Name: Last Name: Home Zipcode:	Gender: M F Smoker? Yes No	Type of Plan: Individual Family Waiving Coverage If Waiving, State Reason:	Date of Birth: Salary (see note):	Weekly Work Hours: Position (see note):

First Name: Last Name: Home Zipcode:	Gender: M F Smoker? Yes No	Type of Plan: Individual Family Waiving Coverage If Waiving, State Reason:	Date of Birth: Salary (see note):	Weekly Work Hours: Position (see note):

First Name: Last Name: Home Zipcode:	Gender: M F Smoker? Yes No	Type of Plan: Individual Family Waiving Coverage If Waiving, State Reason:	Date of Birth: Salary (see note):	Weekly Work Hours: Position (see note):

First Name: Last Name: Home Zipcode:	Gender: M F Smoker? Yes No	Type of Plan: Individual Family Waiving Coverage If Waiving, State Reason:	Date of Birth: Salary (see note):	Weekly Work Hours: Position (see note):

Note: Salary and Position information is required ONLY when requesting Short-Term Disability, Long-Term Disability, or Life Insurance.

MDSIS-Spring Insurance Group, LLC | 200 Friberg Parkway, Suite 2006 | Westborough, MA 01581

Phone: 800.821.6033 | Fax: 508.898.0068