..:: GCADA - Group Insurance Quote Form ::..

Upcoming Events: Seminar Schedule

Professional Automotive Sales - Next Level Training - Building Value and More!
Wednesday, July 24, 2024 - 8:30am-4:00pm
GCADA - 9150 S. Hills Blvd. Broadview Hts. 44147
Members: $285/pp Non-Members: $500

Taking The Lead On Used Car Sales and Profitability
Wednesday, July 17, 2024 - 10am-12pm
ADS - 4836 Brecksville Rd. Richfield, OH 44286
Course has been postponed - new date TBD

Forklift Safety Training & Certification for Dealership Employees
Wednesday, July 10, 2024 - 9am-12pm
BMW Cleveland - 6135 Kruse Dr. Solon, OH 44139
SAFE: $0 GCADA Member: $50/pp Non-Member: $100/pp

HAZMAT Training, Testing & Certification
Tuesday, July 09, 2024 - 9am-12pm
GCADA - 9150 S. Hills Blvd. Broadview Hts. 44147
SAFE:$0 GCADA Member: $45/pp Non-Member:$90/pp

Service Department Legal Issues - Boardman
Thursday, June 20, 2024 - 10am-1pm
Holiday Inn Boardman
Members: $75/pp Non-Member: $150/pp

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