Free Quote

Request a complimentary no-obligation health plan quote today by completing the questions below:

Indicates required field

Legal Company Name

Contact Person(s)

Email Address

Address

Address 2

City

State

ZIP

Phone Number

FAX Number

Type of Business

Describe the business products and services

Number of full-time employees (30 hours or more).

Do you currently offer a health plan to your employees?

If you are working with an insurance broker, please list his/her name

Call the Idaho AGC Health Plan at 208-344-9755 if you need assistance with this form.

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