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Upcoming Events: Seminar Schedule

2023 Workers' Compensation & Safety Management Seminar- Boardman/Youngstown
Friday, May 12, 2023 - 11am-1:30pm
Holiday Inn Boardman
Complimentary: GCADA WC Program Participants
2023 Workers' Compensation & Safety Management Seminar- Cuyahoga Falls
Thursday, May 11, 2023 - 9am-11:30am
Sheraton Suites Cuyahoga Falls
Complimentary: GCADA WC Program Participants
2023 Workers' Compensation & Safety Management Seminar - North Ridgeville
Friday, April 21, 2023 - 11am-1:30pm
Ridgefield Recreation Center
Complimentary: GCADA WC Program Participants
2023 Workers' Compensation & Safety Management Seminar - Independence
Thursday, April 20, 2023 - 9am-11:30am
Independence Civic Center
Complimentary - WC Program Participants
HAZMAT Training, Testing & Certification
Thursday, April 06, 2023 - 9am-12pm
9150 S. Hills Blvd. Broadview Heights, OH 44147
SAFE: $0 GCADA Member: $45/pp Non-Member:$100/p

Group Insurance Quote Form

Please complete the following information and click the "submit" button.

Contact Information:
    Dealer Name
    Person
    Requesting
    Address
    City, ST, ZIP   
    Phone
    Fax
    E-mail Address

Indicate number of employees only, covered in each category:
    Single
    Employee & Spouse
    Employee & Children
    Family
    COBRA
    Total employees currently covered
 
    COBRA eligible, not yet covered
    Emplyees eligible,
    not currently covered
    Total emplyees eligible for coverage

Current Policy Information:
    Current Group Health Carrier
    Date policy expires
  Employee Emp & Sp Emp & Child/ren Family
    Current Rates:
    Renewal rates if available:

Prior Policy Information:
    Prior Group Health Carrier
    Date coverage expired
  Employee Emp & Sp Emp & Child/ren Family
    Prior Rates:

    Are you aware of any serious medical conditions, such as cancer, heart, circulatory
    conditions, etc.? If so, please describe below:
    

Current coverage information:


In-network
Out of network
    Deductibles
    Co-insurance
    Out of pocket maximums

Prescription co-pays:
    Generic   
    Name Brand   
    Non Preferred