YCCA Health Insurance Form
YCCA Health Insurance Form
If YCCA is able to put together a competitive group health insurance program that would be exclusive to members, would you be interested in participating?
If YCCA is able to put together a competitive group health insurance program that would be exclusive to members, would you be interested in participating?
YES
NO
Company Name
Email
*
Number of Employees
Number of Employees
1-5
6-15
16-25
26-35
36-40
41-60
61-75
76-100
100+
Do you have health insurance now for your employees
Do you have health insurance now for your employees
YES
NO
Health Insurance Carrier
Comments:
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