Health Plans and Related Benefits - Census

Health Plans and Services Census
To provide coverage, we will need a complete census of all eligible employees.

Census must include date of birth (or age), gender, occupation, salary/wage, and for health coverages include type of current coverage (single, spouse, child(ren), family, or waived) and employee zip code. Census must include all eligible employees regardless of participation status. If part-time or non-eligible employees are included, please indicate them as such. Individually identifiable information is not necessary.

Electronic submission of data is preferred. You can use the excel form below to provide the information and return by email.

If you would like to receive a quotation to join the Employee Benefit Trust and obtain coverage, please download form below, print, complete, and submit the request for proposal forms to:

Christian Brothers Health Benefit Services
Attn: Underwriting Department

1205 Windham Parkway
Romeoville, IL 60446
Fax: 630.226.2186

Request for Proposal Form

If you would like to speak with a representative or need assistance in completing these forms, please contact any of the following:

John Airola
Managing Director
1205 Windham Parkway
Romeoville , IL 60446.1694
Phone: 800.807.0100 Ext. 2450
Fax: 630.226.2169

Dawn Sterland
Sales Manager (Western US)
Phone 800.807.0100 Ext. 2642
Fax 630.226.2193

Susanne Anderson
Senior Benefit Consultant (Central US)
Phone 800.807.0100 Ext. 3043
Fax 630.679.5159