Request for Rates Small Group - Premera Blue Cross

Please select the type of Life Insurance quote you would like to receive: A. For Groups with 2–9 employees, please select from the following options: 1. Flat Rate $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 Other: 2. Percentage of earnings (1 . x . annual salary up to $50,000 maximum per employee) 3. ................
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