About this form

This Employee Benefits Liability Coverage Quote intake gathers the information needed to generate an accurate benefits-related liability quote for an employer. It captures key details about the applicant’s group medical plans, eligibility rules, paid leave offerings, retirement programs, and other employee benefit practices that underwriters evaluate. The intake also collects general business and contact information to assess risk across relevant lines. All responses automatically map to the appropriate ACORD forms and Employee Benefits Liability supplemental applications, helping agents produce complete, ready-to-submit insurance submissions with minimal manual data entry.