Group Health Quote Made Easy

Complete this simple online form to get started with your quote. If you prefer to meet in person, you can schedule an appointment to meet with an experienced Lang Insurance Service Agent. We will contact you within one business day to present quotes from the companies we represent or to request additional information, if needed. Please give us a call at 636-229-7000 with any questions. We are always here to help!

We care about your privacy.

Would you rather complete a paper copy? Print PDF Version
Would you rather complete a digital copy? Downloadable Excel spreadsheet

* Indicates a required field

Group Health Information
Which Group Plans are you interested in? (check all that apply): *
Medical
Disability
Life
Dental
Vision
Contact Information
Current Insurance Information
Employee Information

Employee information can be filled out on the Employee Information downloadable Excel spreadsheet and e-mailed, mailed or faxed to our office.

Additional Comments
Confirmation
Email     Phone