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Steve Shorr Insurance
Employer Group Proposals
Just enter your census

Census Form

Video Introduction

Steve Shorr, President


AB 1672
Qualification Rules
Blue Cross-Anthem
Aetna
Kaiser
Cal Choice
PacifiCare - UHC
Health Net
Blue Shield
Health Reform
Self Funded Plans
Dental
Vision
Section 125
Disability
Resources
AFLAC
Site Map
Root Home Page
 


Use this form if you prefer putting your employee census on PAPER or Excel Spreadsheet Format Templet rather than ONLINE
Print this form off, or use the Excel Templete - complete it and then email, 1st class mail or fax 310.519.1359  it to us.

 

Excel Spreadsheet Format
Census Form

date of birth should be a numeric date string in the format of mm/dd/[yy]yy

 

This form works for all the companies we represent:

Kaiser
Health Net
Blue Cross
Blue Shield
Cal Choice
Ben E Lect
Aetna

Use this form if you prefer putting your census on PAPER rather than ONLINE.

Parent Page Offering Different Plans? Management Carve Out Common Ownership Census Form

Simple explanation of
AB 1672 & Rating Adjustment Factors (RAF)
CHCF Site
Small Group Rules CHFC Website

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Need Help? 
Have a Question?

(310) 519-1335
 Steve@SteveShorr.com

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