Contact

The LEB Insurance Group – HQ
21 East 2nd Street, Suite 103
Fond du Lac, 54935
920-243-4100

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Do you have coverage now?
What do you primarily want to use health coverage for?
- Emergency
- Doctor Visits
- Rx
What is more important to you?
- Better Coverage
- Lower Premiums
Effective date?
Do you have a Qualifying Life Event?
Current Qualifying Life Event (within 60 days)
Define Other:
Is there any particular Doctor or Clinic that you need to be In-Network?
Is anyone applying for coverage planning on becoming pregnant this year?
Would you like to see quotes with Dental or Vision?
Range you feel you can afford monthly for this coverage?
What is your expected adjusted gross annual household income for 2018?
Household size? (everyone on tax return)
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