Fill Out and Submit a Quote-Request Form

Get a quote by downloading the quote-request form. Complete it based on the instructions included in the form and email it to us. You will receive:

1. An initial quote reflecting gross rates for all plans within 72 hours.
2. A second form used to obtain an enrollment quote that reflects your reference plan selection and defined contribution.
3. Employee enrollment worksheets to help your employees view available health plans and costs, so they can choose the coverage that is right for them.

Ready to apply now?

The Covered California for Small Business Employer Portal is designed to help you manage your company’s health and dental plans from one convenient location.