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BBD Online Demo

For your convenience, we have provided a way for you to electronically request a quote from BBD. Please complete and submit the following Request for Quotation form along with an Employee data sheet, to the appropriate BBD New Business department.

Request for Quotation

Name of Employer
Address of Employer
Phone
Fax
Nature of Business
Years in Business
Present Insurer(s)
Years with Present Insurer
Renewal Date
Name of Advisor
Email of Advisor
Phone Number of Advisor
Reason for Marketing
Attach Data Sheet To use BBD's Employee Data Sheet, click HERE.
Comment
Present Insurers(s)
# Period Total Premium Paid Claims
1 $ $
2 $ $
3 $ $
Rate History
Benefit Current Rates Renewal Rates
Life Insurance $ $
AD/D&D $ $
Dependent Life $ $
Short Term Disability $ $
Long Term Disability $ $
Critical Illness $ $
Extended Health Services $ $
Dental Care - Single $ $
Dental Care - Couple $ $
Dental Care - Family $ $
Benefit: Life Insurance and AD/D&D
Benefit Amount
Maximum Benefit
Benefit: Dependent Life
Benefit Amount
Benefit: Short Term Disability
Benefit Amount % Maximum $ per week
Benefit Commencement/Duration day Accident day Sickness weeks
Taxability of Benefits
Optional Coverage 1st day Hospital
STD Experience
# Period Premium Claims
1 $ $
2 $ $
3 $ $
Benefit: Long Term Disability
Benefit Amount % of monthly salary
or % of the 1st $ of monthly salary, plus 50% of the balance
Maximum Benefit $ per month
Elimination/Benefit Period EP days BP
Taxability of Benefits
Optional Coverage COLA % commencing after years
Benefit: Critical Illness
Benefit Amount $
Benefit: Extended Health Services
Pay-Direct Drugs Deductible per prescription
Pay-Direct Drugs Coinsurance %
EHS Calendar Year Deductible $ single $ family
EHS Coinsurance %
Paramedical Coverage per practitioner per calendar year
Catastrophic Only HSA Volumes: $
Optional Coverage Individual Drug Limit
Vision Care $per 24 months
Experience
# Period Premium Claims
1 $ $
2 $ $
3 $ $
Benefit: Dental Care
Calendar Year Deductible $ Single $ Family
Coinsurance % Basic, Endo/Perio
Calendar Year Maximum $ for Basic, Endo/Perio
Recall Exams for 6 months for 9 months
Options 50% Major Restorative 50% Orthodontia
Dental Maximum $ Major (combined with Basic) , $ Ortho
Experience
# Period Premium Claims
1 $ $
2 $ $
3 $ $
Benefit: Benaccount ®
Employers HSA Contribution $ Single $ Couple $ Family
Allotment Period
Rolling Type
Submit quote to New Business:

Note: All fields are optional.