Benefits Connection Exchange

Dental & Vision Group Employee Census

Please complete the census for ALL employees and their enrollment status.
Employer Information
Company Name: *
Contact Name: *
Contact Email: *
Contact Phone:
Employee Information
  Name Enrollment Status Date of Birth Date Employed
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
* = Required Field
Return to Homepage
Get A Quote
Button Group Healthcare Plans 
Button Group Dental Plans 
Button Group Vision Plans
Benefits Connection Item LegalShield
Button Workers Compensation
Button Individual Healthcare
Button How To Get A Quote & Enroll
Button Get Enrollment Forms
Button Meet Our Partners
Button See Our Insurance Companies
Button Contact Us        
Button Our Privacy Notice
 Toll Free: 800.486.1244
 Local: 302.654.8823

Insurance Products provided through
AIG Logo
 Broker since 1980
302-654-8823
Wilmington, DE 19801
Allen@AllenInsurance.com





 
 
 
 

 


  
 

 
 

 
 

 



      
           
   




Insurance News

Thu, 28 May 2020 05:19:09 +0000
The ongoing COVID-19 pandemic has tragically resulted in the deaths of 100,...
Thu, 28 May 2020 05:00:30 +0000
New York Governor Andrew Cuomo donned a face mask and rang the opening bell...
Thu, 28 May 2020 05:00:21 +0000
The representatives of three children who attended a Polk County, Ore. day ...