Your Subtitle text

Robert Thompson 303-635-2292 bob@bbs4me.com

 

Tracie Alvarado
720-460-1316
tracie@bbs4me.com

 Thank you for visiting our website. We look forward to helping you with all your insurance needs. 

PO Box 35-0241
Westminster, CO 80035





 

Contact Information

Please fill out the following information, the more information you can provide us the more accurate your quote will be. 

Contact Name: *
Address Street:
City:
Zip Code: * (5 digits)
County: *
State: *
Daytime Phone: *
Email: *
 Part l: If you are interested in determining if you qualify for financial assistance complete this section (if you do not want to apply for a subsidy, skip to Part ll)
Tax Return: How many people will be on your Federal Tax Return for 2016? 
Income: Based on your best guess, what will be your total household income in 2016?
Pregnant or Disabled?: Are you, or anyone to be insured, currently pregnant or disabled? 
 Part ll: About you- Who do you want to have insured? 
Person 1: Name
Date of Birth:
Relationship:
Tobacco Use:
Person 2: Name:
Date of Birth::
Relationship::
Tobacco Use:
 Person 3: Name:
Date of Birth::
Relationship::
Tobacco Use:
Part lll: * Do you Currently have health insurance? 
IF YES:: Who is your current carrier: 
IF YES:: What is your current deductible: 
IF YES:: What is your current monthly premium: 
Part lV What type of plan are you looking for in 2016?  Price vs Benefits ? Deductible?

Gold - Low Deductible of $500 -$1000

Silver - Medium Deductible of $2000 -$3000

Bronze - High Deductible of $4500 -$6,850

HSA Plan - (Health Savings Account)

Physician?: I have a physician that I would like to stay with:
Budget?: What is your budget for your monthly premium?
Part V: Do you have a preferred Insurance Carrier?

AnthemCigna Humana
KaiserRMHPUnitedHealthOne
Security Code: *