Request a Quote

If you are an employer in the Food Industry, Pharmacy or Hardware Retailer, you qualify to participate in our Trust. To learn about your options and cost to participate simply complete the information below.

THREE WAYS TO SUBMIT YOUR REQUEST FOR A QUOTE:

  1. Complete this form on-line
  2. Print this form and fax it to us at (503)-968-2817
  3. Print this form and mail it to us

We will return your rate and plan information within two business days of receipt.

Here is the information we need to prepare your quote:

Note: All contact information is required.

Contact Information
Business Name
Contact Name
Number of employees in Oregon
Number of employees in Washington
Number of employees in Alaska
Total number of employees
Mailing Address
City   State
Zip
Phone
Fax
Email

Participation
Requirements for participation in the Plan include:

  1. 75% of eligible employees must participate
  2. Eligible employees must work a minimum of 17.5 hours per week
  3. At least 2 employees must participate

Tell us about the employees you wish to insure:
Note: To qualify, employees must work at least 17.5 hours per week with a minimum of 2 employees participating.

How many employees want coverage only for themselves?
How many would like coverage for themselves and spouse?
How many would like coverage for employee (no spouse) and children only?
How many would like full family coverage?

Benefit Options
Once we receive your request, a proposal will be prepared that provides rates for your group for all our benefit plans as seen on the Benefits Summary.

NOTE: All plans include vision, short-term disability, and life insurance benefits.

Other Plans
Would you like more information on any of these additional enhancements?

  • High Deductible Plans that can reduce annual costs
        (partially self-insured for over 50 employees)
  • Dental Coverage
  • 125 Plan (Flexible Benefits)
  • On-job coverage for Owners (replaces work comp)

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WESTERN GROCERS EMPLOYEE BENEFITS TRUST

Western Grocers Trust
C/O Cypress Benefit Administrators
PO Box 22166
Portland, OR 97269
800-777-3603
503-968-2360
fax 503-968-2817
info@westerngrocerstrust.com
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