Online Medical Questionnaire Instructions

Your employer is considering placing their upcoming renewal of Medical and Prescription Drug Re-insurance coverage with East Coast Underwriters, LLC.
Individual Medical Questionnaires (IMQ’s) are documents filled out by each employee who is requesting insurance coverage. An IMQ thoroughly describes you (and your dependents) current and past medical diagnosis, treatment, and medication. IMQ’s are extremely important in order for your employer group to have the best rates possible. The questionnaire must include information on you and your eligible dependents.

The information you provide is for re-insurance purposes only and will not impact your coverage under the plan of benefits.

In order to accurately underwrite your employer’s re-insurance group coverage, we need each employee or participant on the following to complete the Individual Medical Questionnaire (IMQ):

Each eligible employee or participant on:

To access the Questionnaire, please choose your language below.

East Coast Underwriters    East Coast Underwriters

If you have any questions regarding the completion of the questionnaire, please contact:
East Coast Underwriters, LLC
Monday – Friday, 8 a.m. to 5 p.m. Eastern Time

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