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    • Contact USHL sales support at (844) 828-5968

USHL Metal Plans

Request For Quote

Complete all fields for pricing on USHL Metal Plan portfolio. Note: Metal Plan quoting requires DOBs on all applicants.

Requesting Party


Name:

Company:

Telephone:

Are You An Agent?:
Email:

(For quote delivery.)
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Quoting Information


Company Name:

Company Address:

Zip:

State
Plan:
Effective Date:
Your date format is invalid unless its mm/dd/yyyy
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File Location:




Note: You must enter enrollee data in the order of Employee, followed by applicable Spouse, and then applicable Dependents for accurate output.
Enrollee
Last Name
First Name
Date Of Birth
Contract Type
Medical
Tobacco Use
Zip Code
Your date format is invalid unless its mm/dd/yyyy

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