Quoting in the Mid/Large Market


When submitting a group for quote in the mid/large market (greater than 50 Average Total Number of Employees), please use the appropriate Rate Request Form below:

BNGA Rate Request Form Q3 2024


In addition to the completed rate request form, please submit:

  • An Employee Count Form (Based on the average total number employees from the previous calendar year)
  • Census
  • Past, current, and renewal rates
  • Specific plan design summaries
  • Claims experience (for groups with 100 or more or who are self-insured)
  • HRA funding arrangement if applicable

Please use this link to send Group rate requests securely.


Links to helpful sites:

OSHA (SIC Look Up)
Zip Express (County/Zip Code Reference)


Send Rate Requests Securely


Click Here

Small Market Quotes (2-50)


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