Census Request Materials

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Census Request
Census Request “Sample”
Census Request

On each employee and each dependent, we will need the following. 

    • Date of Birth
    • Gender (male or female)
    • Zip Code of Residence and Work (only need work zip for employees, not dependents)
    • Whether they are a tobacco user or not

If they are part-time, we do not need dependent information.

Please remember that we need this information for all insureds, including dependents. The census also needs to
include part-time employees, even though they are not eligible for coverage, as well as employees who have declined due to other coverage.

In addition to the census, we also need your current carrier (if any), and a copy of your current rates and benefits.

Census Request “Sample”

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Get Ready Set GO!!!

Let Commercial Benefit Services, LLC. give you a quote this year.