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Request a Quote

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 Spouse $5,000 / Child $2,500 Spouse $10,000 / Child $5,000 Spouse $20,000 / Child $10,000 Benefit: Short Term Disability Benefit Amount % Maximum $ per week Benefit Commencement/Duration day Accident day Sickness weeks Taxability of Benefits Taxable Non-Taxable 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 Taxable Non-Taxable 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 $300 $500 per practitioner per calendar year Catastrophic Only HSA Volumes: $ Optional Coverage $1000 $2500 $10000 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 Monthly Quarterly Semi-Annual Annual Rolling Type Contributions Claims None Submit quote to New Business: East West Note: All fields are optional.

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