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Agent/Broker Proposal Request

Agents and brokers may complete this form for a formal proposal by mail or fax. Our staff will work diligently to forward your proposal within 3 business days. If you need help completing this form, please call us at (501)312-4607 or (888)236-7242 (Toll Free) or e-mail: marketing@aiba.com

To begin, please select the number of employees to be covered:

American Denticare
Employers Choice Health Plan
Physicians Medical Review
Advanced Insurance Brokerage
Employers Choice Health Alliance
Advanced Insurance Administration

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