Medical Quote Form
Download and complete Medical Quote Form
1. Complete the Medical Quote Form and return to the HR Benefits Team at firstname.lastname@example.org
2. A member of the HR team will follow up with you in 5-7 business days and will provide your Personalized Quote - Major Medical and Voluntary Benefits (Dental and Vision) Plan to review.
3. Make final selections on your Personalized Quote for Major Medical and Voluntary Benefits (Dental and Vision). Return the completed and signed CalChoice Medical Application and the MetLife Application.
4. A member of the HR team will confirm enrollment plan start dates and will setup payroll deductions.
*Major medical quotes are unique to each individual and are tailored to where you live. Therefore, plan details will be sent with the personalized quote that is provided after the Medical Quote Form is processed.