Pennsylvania Disability Insurance Quotes

** Information received from this Pennsylvania Group Disability Insurance quote request form sent

to JDC Benefits, LLC will be for our use only and will not be sold, given to or distributed to any

other parties. A quote will be based on the small business disability insurance information provided

and does not guarantee acceptance of the risk by us. The precise coverage afforded is subject to

meeting underwriting guidelines, and the terms, conditions and exclusions of the policy as issued.

By submitting this request you acknowledge that this is neither an offer to insure nor a

guarantee of insurance. Completion of this form does not entitle you to Group Employee

Disability Insurance. We are licensed in Pennsylvania, New Jersey, and Delaware. We will not

provide quotes to businesses located in other states.

Business Name:
Premises Address:
City:     State:     Zip Code:
Contact Name:
Phone #:    Ext #:    Years in Business:
Email Address: (Required)
Description of Operations or SIC code:

Current Insurance Company:
Policy Expiration Date:          (mm/dd/yyyy)

GROUP DISABILITY INSURANCE COVERAGE INFORMATION:
Do you currently offer short term disability insurance to employees?
Do you currently offer long term disability insurance to employees?
Length of Group Disability Coverage Needed?

Group Disability Coverage For?
Type of Group Disability Coverage Needed?
How many employees to be insured?

Monthly Benefit Amount For Each Person Insured: $
Or Enter a Different Monthly Benefit Amount:         $
Benefit Period Desired For Each Person Insured:
Elimination Period Desired For Each Person Insured:
Payment Mode:

Does any employee to be insured have a hazardous job? Yes No
If Yes, how many have hazardous jobs?

Are any employees to be insured active members of the military reserves? Yes No
If Yes, how many are active members of the military reserves?

Explain Any Recent Workers Compensation Claims Below.

Additional Information

Click on the "Submit Quote Information" button below to send your New Jersey,
Delaware, or Pennsylvania Group Disability insurance quote request.**

We are your local Allentown, PA area insurance agency, offering affordable
employee group disability insurance plan premiums and services for
businesses in the following Pennsylvania cities and counties: Philadelphia
County, Delaware County, Montgomery County, Chester County, Bucks
County, Lehigh County, Berks County, Lancaster County, York County,
Emmanus, Hellertown, Whitehall, Cetronia, East Texas, Lanark, Dorneyville,
Wagnersville, Catasauqua, Walbert, Farmersville, Stiles, Friedensville,
Mechanicsville, Hanover, North Catasauqua, Stroudsburg, King of Prussia,
Springfield, Woodlyn, Chester, Norwood, Ridley Park, Prospect Park, Folcroft,
Darby, Swarthmore, Drexel Hill, Rutledge, Yeadon, Upper Darby, Secane,
Milmont Park, Garden City, Wallingford, Morton, Aldan, Primos, Pilgrim
Gardens, Colwyn, Lester, Essington, Eddystone, Landsdowne, Fernwood,
Milbourne, Havertown, Broomall, Penn Wynne, Merion Station, Wynnewood,
Haverford, Penn Valley, Bala-Cynwyd, Ardmore, Rosemont, Overbrook,
Belmont Hills, Villanova, Rebel Hill, Gulph Mills, Gladwyne, Conshohocken,
Kings Manor, Swedeland, Swedesburg, Bridgeport, Norristown, Lafayette
Hill, Plymouth Meeting, Erdenheim, Oreland, Flourtown, Ardsley, North Hills,
West Conshohocken, La Mott, Cheltenham, Melrose Park, Elkins Park,
Glenside, Wyncote, Roslyn, Abington, Huntingdon Valley, Rydal,
Meadowbrook, Jenkintown, Hollywood, Rockledge, Somerton, Bustleton,
Torresdale, Holmesburg, Tacony, Kensington, Feltonville, Frankford, Olney,
Andalusia, Cornwells Heights, Bridgewater, Croydon, Bensalem,
Nottingham, Bristol, Edgely, Newportville, West Bristol, Strafford, Devon,
Berwyn, Port Kennedy, Newtown Square, Gradyville, Cheyney, Concordville,
Narberth, Milltown, Westtown, Trainer, Marcus Hook, West Chester,
Lancaster, York, Reading, Bethlehem, Pottstown, Coatesville, Kulpsville,
Warminster, Montgomeryville, Levittown, Valley Forge, Malvern, Green Tree,
Paoli, Devault, Chatwood, Goshenville, Sugartown, Glenloch, Chester
Springs, Audubon, Eagleville, Evansburg, Worcester, Blue Bell, Center
Square, Fort Washington, Philadelphia, Doylestown, Chalfort, Quakertown,
Perkasie, Sellersville, Soudertown, Willow Grove, Warrington, Morrisville,
Ambler, Lower Gwynedd, Washington Crossing, New Hope, Richboro,
Feasterville, Southampton, Langhorne, Holland, Newtown, and Yardley, PA.

We also offer affordable group disability insurance services to businesses located in the following
Delaware counties and cities: Castle County, Kent County, Sussex County, Newark, Claymont, Middletown,
Dover, Milford, Georgetown, Seaford, Yorklyn, Centerville, Talleyville, Greenville, Newport, New Castle,
Hillcrest, Elsmere, Penny Hill, Graylyn Crest, Ardentown, Hockessin, Delaware Heights, Devonshire, Arden,
Fairfax, Dunleith, Meadowood, Sherwood Park, Wilmington Manor, Lancaster Village, Ashland, Penn Acres,
Green Acres, Darley Woods, Wilmington Gardens, Ogletown, Delaware City, Woodland Beach, Bay View
Beach, Wilmington, DE; as well as offering group disability insurance services in the following New Jersey
counties and cities: Mercer County, Burlington County, Camden County, Gloucester County, Salem County,
Cumberland County, Atlantic County, Camden, Vineland, Ewing, Cherry Hill, Pennsauken, Willingboro,
Collingswood, Palmyra, Delran, Cinnaminson, Moorestown, Riverside, Gloucester City, Bellmawr,
Runnemede, Burlington, Edgewater Park, Haddonfield, Maple Shade, Princeton, Mercerville, Slackwoods,
Yardville, White Horse, Mansfield, Atlantic City, Margate City, Ocean City, and Trenton, NJ.