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 Business Mailing Address Address Address 2 City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming 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? - None -YesNo 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.