Marsh Affinity Group Services
California Optometric Association
Interest Form
Interested in learning more about the Association sponsored insurance programs? Complete and send this interest form, and more information will be mailed to you right away!
Name
Practice Name
Address
Suite/Apt
City
State
Zip Code
Phone Number
Fax Number
E-mail Address
Contact Name
Professional Liability Program
Underwritten by The Chicago Insurance Company
Workers' Compensation Program
Underwritten by Republic Indemnity Company of America
Business Owners Package Program
Underwritten by Zurich Precision America
Employment Practices Liability Insurance
Medical Programs Individual, or Small Groups
High Deductible Health Plans
Blue Cross - For Individuals and Small Groups of 2–50
PacAdvantage - Small Groups of 2–50
Dental Program
Underwritten by Delta Dental
Term Life Program
Underwritten by Hartford Life Insurance Company
Group Universal Life Program
Underwritten by Metropolitan Life Insurance Company
Accidental Death & Dismemberment Program
Underwritten by Unum Life Insurance Company of America
Long Term Disability Program
Plan A: Underwritten by Hartford Life Insurance Company
Plan B: Underwritten by New York Life Insurance Company
Business Overhead Expense Program
Underwritten by Unum Life Insurance Company of America
Long Term Care Program
Underwritten by Unum Life Insurance Company of America
Auto & Homeowners Program
Underwritten by Liberty Mutual
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Page Last Updated: 6/13/2006

© 2006 Seabury & Smith Insurance Program Management
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