How long in Business:
Your business location Zip:
What is your Business Category? (Click Here to find the NCAIS Industry Category)
Do your employees smoke tobacco: Y
Do they drink alcohol: Y
If Yes how often:
(how many drinks per week/)
Have they had illicit drugs in the past 12 months? Y
How many employees do you have?
Is your employer making payments/part-payments for your health cover? Y
What are you seeking to spend monthly?
Are you currently insured? Y
If yes with whom?