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Group Health Quote

We offer Group Health Insurance for Virgin Islands businesses with multiple employees (minimum of 2). If you have 11 or more employees, please email carl@insurancevi.com for a Large Group Form and to discuss a quote.

Please fill out the information below in order for us to prepare a quote for US Virgin Islands Group Health Insurance.
Scroll to the bottom and click the orange “Submit” button once all details are complete.

Name(required)

Email(required)

Business Name(required)

Tax ID

Contact Telephone(required)

No. Employees to Insure(required)

Please fill in Employee details below. For “Additional Insured” please enter sex/age of each individual (if any).
Example: Spouse M, 36; Child F, 6; Child M, 3

Employee 1

Employee1 Age(required)	Gender(required) Male Female
Type of Coverage(required)
Additional Insured

Employee 2

Employee2 Age(required)	Gender(required) Male Female
Type of Coverage(required)
Additional Insured

Employee 3

Employee3 Age	Gender Male Female
Type of Coverage
Additional Insured

Employee 4

Employee4 Age	Gender Male Female
Type of Coverage
Additional Insured

Employee 5

Employee5 Age	Gender Male Female
Type of Coverage
Additional Insured

Employee 6

Employee6 Age	Gender Male Female
Type of Coverage
Additional Insured

Employee 7

Employee7 Age	Gender Male Female
Type of Coverage
Additional Insured

Employee 8

Employee8 Age	Gender Male Female
Type of Coverage
Additional Insured

Employee 9

Employe9 Age	Gender Male Female
Type of Coverage
Additional Insured

Employee 10

Employee10 Age	Gender Male Female
Type of Coverage
Additional Insured

Additional Notes

Gotts & Associates Insurance is a Full Service Insurance Agency licensed in the US Virgin Islands since 1992.

Health, Life, Homeowners and Business Insurance.

(340) 332-1579
carl@insurancevi.com
Gotts & Associates Insurance
P.O. Box 1150
Christiansted, VI 00821

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