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} .test-w_contact-lightbox-individuals .info-section { position: initial; width: auto; } .test-w_contact-lightbox-individuals .info-section .top { padding: 38px 21px 0px; } .test-w_contact-lightbox-individuals { width: 100%; height: 100%; margin-top: auto; margin-left: auto; position: fixed; top: 0; left: 0; overflow-y: scroll; -webkit-overflow-scrolling: touch; } .form-bg { float: none; min-width: auto; padding: 0 20px; margin: 20px 0 0px; max-width: unset; text-align: center; } a.clear-date-time.textlink { margin: 30px 0 30px 0; display: inline-block; text-decoration: underline; margin-left: auto; } /*mobile */ .close-bg { width: 57px; height: 54px; position: absolute; top: 0px; right: 0px; background: none; } .test-w_contact-lightbox-individuals .close::after { content: ""; width: 30px; height: 30px; background: url(//www.360jue.com/_global-assets/images/icons/close-3b.png) 0px 0px no-repeat; cursor: pointer; display: block; width: 28px; height: 24px; position: relative; top: -11px; left: 11px; background: url(//www.360jue.com/_global-assets/images/sprites/layout/sprites-sfd5c0480fb.png) 6px -622px no-repeat; } .test-w_contact-lightbox-individuals .close { background: none; width: 100%; height: 100%; } .test-w_contact-lightbox-individuals .dropdown-box, .test-w_contact-lightbox-individuals .time-dropdown { margin-bottom: 10px; width: 97%; } .form-main-bg .raq-complete-panel { float: left; width: 100%; } .test-w_contact-lightbox-individuals .close:active:after { content: ""; filter: invert(1); } .close-bg:active { background: #fff; } } </style> <script id="test-contact-lightbox-individuals-tpl" type="text/html"> <div class="test-w_contact-lightbox-individuals"> <div class="form-main-bg"> <div class="close-bg"><button type="button" class="close">close</button></div> <div class="sidebar-bg"> <div class="info-section"> <div class="top"> <h6>Request a Quote</h6> <p>Aflac is insurance that pays cash benefits, to help pay for things that major medical may not cover.</p> </div> <div class="middle"> Fill out our <strong>Contact Form</strong> and we'll call you <em>or</em> Call Us now at <a href="tel:800.992.3522">800.992.3522</a> </div><a class="manage-account" href="//my.aflac.com/portal/server.pt?open=512&objID=639&mode=2" target= "_blank">Manage My Policy</a> </div> </div> <div class="form-bg"> <div class="legend"> Provide your information so an Aflac agent can reach you. </div> <form method="post"> <input name="offering" type="hidden" value="Individual"> <input name="language" type="hidden" value="English" /> <div class="contact-fields"> <div class="flex_columns"> <div class="flex_2col"> <span class="input-text firstname" data-manual="1"><input name="firstname" title="First Name" class="required" id= "firstname" type="text" maxlength="150" placeholder="First Name *"></span> </div> <div class="flex_2col"> <span class="input-text lastname" data-manual="1"><input name="lastname" title="Last Name" class="required" id= "lastname" type="text" maxlength="150" placeholder="Last Name *"></span> </div> <div class="clearfloat"></div> </div> <div class="flex_columns"> <div class="flex_2col"> <span class="input-text phone" data-manual="1"><input name="phone" title="Phone Number" class="required" id= "phone" type="tel" maxlength="12" placeholder="Phone Number *"></span> </div> <div class="flex_2col"> <span class="input-text zipcode" data-manual="1"><input name="zipcode" title="Zip Code" class="required" id= "zipcode" type="tel" maxlength="5" placeholder="Zip Code *"></span> </div> <div class="clearfloat"></div> </div> <div class="flex_columns"> <div class="flex_2col"> <span class="input-text email" data-manual="1"><input name="email" title="Email" class="required" id="email" type= "email" maxlength="255" placeholder="Email *"></span> </div> <div class="flex_2col"> <div class="requirement-info"> * fields are required </div> <ul class="misc"> <li> <p>Would you like an Aflac agent to call asap?</p><label class="checkbox"><input name="yesmeet" type= "checkbox"> Yes</label> <label class="checkbox"><input name="nomeet" type="checkbox"> No</label> </li> </ul> </div> <div class="clearfloat"></div> </div> </div> <div class="form_progress"></div> <div class="contact-time-selection" style="display: none;"> <div class="tabs"> <div class="flex_columns"> <div class="tab"> <input class="now-date" name="date" type="hidden"> <input class="now-time" name="time" type="hidden"> <input class="now-contact-me-type" name="contactMeType" type="hidden"> <div class="eta"> Press submit for an Aflac agent to call you <span class="value">within 15 minutes</span> </div> </div> <div class="tab"> <div class="divider-container"> <div class="divider"></div> <div class="divider-text"> or </div> <div class="divider" style="right: 0%;"></div> </div> <input class="now-contact-me-type" name="contactMeType" type="hidden"> <p class="later-info">If you need to schedule another time for a call, <span>select a date and time that works with your schedule below:</span></p> <div class="dropdown-row"> <div class="dropdown-box date-dropdown" data-manual="1" data-scroll-threshold="4"> <div class="dropdown-title"> <p>Select a Day</p> </div><select name="date"> </select> </div> <div class="time-dropdown-box time-dropdown" data-manual="1"> <div class="dropdown-title"> <p>Select Time</p> </div><select name="time"> </select> </div> </div><a href="#" class="clear-date-time textlink">Reset Date & Time Selection</a> </div> </div> </div> </div> <div class="flex_columns" style=" /* display: none; */"> <input class="textbutton is-blue submit" type="submit" value="Submit"> <div class="clearfloat"></div> </div> <p style="font-size: 13px;line-height: 100%;margin: 15px 0 14px;">By hitting submit, I agree to receive autodialed calls, to include scheduling reminders, and texts from Aflac, an independent contractor Aflac associate, and an Aflac Partner, such as Sutherland Global Services or 明确 Link Insurance Agency, LLC working at Aflac's request, at the number provided. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. I understand I may also receive text messages about the status of my Aflac application and am not required to provide my consent as a condition of accessing Aflac's website or purchasing Aflac's products.</p> </form> </div> <div class="raq-complete-panel"> <div class="thanks"> <div class="title"> Thank You! </div> <p>An Aflac agent will call you<br> <span class="eta">within 15 minutes.</span></p> </div> <div class="info"> <p>Your confirmation number is <span class="number"></span>.</p> <p>If you have any questions regarding your request, contact us at <a class="textlink" href= "mailto:salesinquiry@aflac.com">salesinquiry@aflac.com</a></p> <p>Please provide your confirmation number listed above for reference.</p> </div><!-- START OF SUTHERLAND CHANGES --> <div id="aflac-connect" class="chat-launcher"> <p class="launcher-text">START NOW</p> </div><!--<div id="locl-messenger"></div>--> <!-- END OF SUTHERLAND CHANGES --> </div> <div class="clearfloat"></div> </div> </div> </script> <script id="contact-lightbox-individuals-tpl" type="text/html"> <div class="w_contact-lightbox-individuals"> <div class="lightbox-content"> <div class="info-section"> <div class="top"> <h6>Request a Quote</h6> <p>Aflac is insurance that pays cash benefits, to help pay for things that major medical may not cover.</p> </div> <div class="middle"> Fill out our <strong>Contact Form</strong> and we'll call you <em>or</em> Call Us now at <a href="tel:800.992.3522">800.992.3522</a> </div> <a class="manage-account" href="//my.aflac.com/portal/server.pt?open=512&objID=639&mode=2" target="_blank">Manage My Policy</a> </div> <div class="form-section"> <ol class="progress-indicator"> <li class="is-current">1. Contact Information</li> <li>2. Call time</li> </ol> <a class="close" href="#">关</a> <div class="raq-form-panel"> <div class="form-steps"> <form action="#" method="POST"> <input name="offering" type="hidden" value="Individual"> <input name="language" type="hidden" value="English" /> <fieldset class="form-step interests"> <div class="legend">Please select at least one Aflac insurance product.</div> <p>I'm interested in:</p> <ul class="interest-list"> <li> <div class="checkbox-holder"> <label class="checkbox has-orange-fg" data-manual="1"> <input name="offering_1" type="checkbox" value="Accident"> 事故</label> </div> </li> <li> <div class="checkbox-holder"> <label class="checkbox has-orange-fg" data-manual="1"> <input name="offering_2" type="checkbox" value="Cancer/Specified-Disease"> 癌症/Specified-Disease</label> </div> </li> <li> <div class="checkbox-holder"> <label class="checkbox has-orange-fg" data-manual="1"> <input name="offering_3" type="checkbox" value="Critical Care and Recovery"> Critical Illness</label> </div> </li> <li> <div class="checkbox-holder"> <label class="checkbox has-orange-fg" data-manual="1"> <input name="offering_4" type="checkbox" value="Dental"> Dental</label> </div> </li> <li> <div class="checkbox-holder"> <label class="checkbox has-orange-fg" data-manual="1"> <input name="offering_5" type="checkbox" value="Juvenile Life"> Juvenile Life</label> </div> </li> </ul> </fieldset> <fieldset class="form-step contact-info" data-di-form-track data-di-form-id="individuals-form-contact-info"> <div class="legend">Provide your information so an Aflac agent can reach you.</div> <div class="form-fields"> <div class="row"> <span class="input-text firstname" data-manual="1"> <input name="firstname" type="text" placeholder="First Name" title="First Name"> </span> <span class="input-text lastname" data-manual="1"> <input name="lastname" type="text" placeholder="Last Name" title="Last Name"> </span> </div> <div class="row"> <span class="input-text phone" data-manual="1"> <input name="phone" type="tel" placeholder="Phone" title="Phone"> </span> <span class="input-text zipcode" data-manual="1"> <input name="zipcode" type="tel" placeholder="ZIP Code" title="ZIP Code"> </span> </div> <div class="row"> <span class="input-text email" data-manual="1"> <input name="email" type="email" placeholder="Email" title="Email"> </span> </div> </div> <p style="margin-bottom: 10px">All fields are required.</p> <!--<p style="font-size: 10px; line-height: 12px;">By hitting submit, I agree to receive autodialed calls, to include scheduling reminders, and texts from Aflac, an independent contractor Aflac associate, and an Aflac Partner, such as Sutherland Global Services or 明确 Link Insurance Agency, LLC working at Aflac’s request, at the number provided. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. I understand I may also receive text messages about the status of my Aflac application and am not required to provide my consent as a condition of accessing Aflac’s website or purchasing Aflac’s products.</p>--> </fieldset> <fieldset class="form-step call-time" data-di-form-track data-di-form-id="individuals-form-call-time"> <div class="legend">Your preferred call time</div> <p class="available"> Monday - Friday <strong id="mf-start-time">8:00 AM</strong> to <strong id="mf-end-time">11:00 PM</strong> ET<br> Saturday & Sunday <strong id="sat-start-time">10:00 AM</strong> to <strong id="sat-end-time">6:00 PM</strong> ET<br> <!--Aflac will be open on January 21, 2019 from 8:00 AM - 8:30 PM.--> </p> <div class="call-options"> <ul class="tab-nav"> <li><a href="#">Call me now</a></li> <li><a href="#">Call me later</a></li> </ul> <div class="tabs"> <div class="tab"> <input class="now-date" name="date" type="hidden"> <input class="now-time" name="time" type="hidden"> <input class="now-contact-me-type" name="contactMeType" type="hidden"> <div class="current-time"> Current time: <span class="value"></span> </div> <div class="eta"> An Aflac agent will call you <span class="value">within 15 minutes</span> </div> </div> <div class="tab"> <input class="now-contact-me-type" name="contactMeType" type="hidden"> <p class="later-info"> Select a date and time you'd like to be<br> contacted by an Aflac agent. </p> <div class="dropdown-row"> <div class="dropdown-box date-dropdown" data-manual="1" data-scroll-threshold="4"> <div class="dropdown-title"> <p>Select a Day</p> </div> <select name="date"> </select> </div> <div class="time-dropdown-box time-dropdown" data-manual="1"> <div class="dropdown-title"> <p>Select Time</p> </div> <select name="time"> </select> </div> <div class="requirement-info">All fields are required.</div> </div> </div> </div> </div> <div class="form-disclaimer"> <p>By hitting submit, I agree to receive autodialed calls, to include scheduling reminders, and texts from Aflac, an independent contractor Aflac associate, and an Aflac Partner, such as Sutherland Global Services or 明确 Link Insurance Agency, LLC working at Aflac’s request, at the number provided. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. I understand I may also receive text messages about the status of my Aflac application and am not required to provide my consent as a condition of accessing Aflac’s website or purchasing Aflac’s products.</p> </div> </fieldset> </form> </div> <div class="progress-nav"> <a class="back" href="#">Back</a> <a class="next" href="#">Next</a> <a class="submit" href="#">提交</a> </div> </div> <div class="raq-complete-panel"> <div class="thanks"> <div class="title">Thank You!</div> <p> An Aflac agent will call you<br> <span class="eta">within 15 minutes.</span> </p> </div> <div class="info"> <p>Your confirmation number is <span class="number"></span>.</p> <p>If you have any questions regarding your request, contact us at <a class="textlink" href="mailto:salesinquiry@aflac.com">salesinquiry@aflac.com</a></p> <p>Please provide your confirmation number listed above for reference.</p> </div> </div> <!-- START OF SUTHERLAND CHANGES --> <div id="aflac-connect" class="chat-launcher"> <p class="launcher-text">START NOW</p> <i class="fas fa-comments"></i> </div> <!--<div id="locl-messenger"></div>--> <!-- END OF SUTHERLAND CHANGES --> </div> </div> </div> </script> <script> (function(){ //start anon var allowed = false; var allowedPages = ["agents"]; for(var i=0; i < location.pathname.split("/").length; i++){ for (var x=0; x < allowedPages.length; x++){ if(location.pathname.split("/")[i] === allowedPages[x] && i < 2){ allowed = true; } } } if(allowed){ require(['/_global-assets/js/common.js'], function(common) { require(['local-agent-require']); }); } })(); </script> <script id="contact-lightbox-local-agents-tpl" type="text/html"> <div class="w_contact-lightbox-local-agents"> <div class="lightbox-content"> <div class="info-section"> <div class="top header-only"> <h6>Local 代理 Form</h6> </div> <!-- <div class="middle bottom-aligned"> Fill out the form and we’ll contact you. <a href="tel:800.992.3522">800.992.3522</a> </div>--> </div> <div class="form-section"> <a class="close is-grey" href="#">关</a> <div class="form-panel"> <form method="POST"> <div class="form-steps"> <div class="form-step getting-started" style="display: block;"> <form action="" method="POST"> <div class="legend"> Please select at least one of the options below to continue: </div> <div class="form-fields"> <div id="individualsproductsonly"> <p><a class="textlink" href="/individuals/default.aspx">Learn about individual policies.</a> <br>For companies with fewer than three employees, please check out our individual and family coverage. <a class="textlink" href="/individuals/default.aspx">Learn more.</a> </p> </div> <div class="captioned-list"> <p>I'm interested in:</p> <ul> <li> <label class="checkbox" data-manual="1"><input name="b2c" type="checkbox" value="individual"> Coverage for myself</label> </li> <li> <label class="checkbox" data-manual="1"><input name="b2b" type="checkbox" value="business"> Coverage for Employees</label> </li> <li> <label class="checkbox" data-manual="1"><input name="agents" type="checkbox" value="agent"> Become an Agent</label> </li> </ul> </div> <!-----END PREQUAL-----> </div> <p class="required-legend"> All fields are required. </p> </form> </div> <div class="form-step contact-info"> <form action="/url_to_post_to" method="POST"> <input type="hidden" name="language" value="EN"> <input type="hidden" name="marketing_program_id" value=""> <div class="form-fields"> <div id="name" class="row two-part"> <span class="input-text name" data-manual="1"><input name="first_name" type="text" placeholder="First Name*" title="First Name*"> </span> <span class="input-text" data-manual="1"><input name="last_name" type="text" placeholder="Last Name*" title="Last Name*"> </span> </div> <div id="address" class="row two-part"> <span class="input-text address" data-manual="1"> <input style="width: 423px" name="address" type="text" placeholder="Address*" title="Address*"> </span> </div> <div class="row three-part"> <span class="input-text zipcode" data-manual="1"><input name="zipcode" type="tel" placeholder="ZIP Code*" title="ZIP Code*"> </span> <span class="input-text phone" data-manual="1"><input name="phone" type="tel" placeholder="Phone*" title="Phone*"> </span> <span class="input-text email" data-manual="1"><input name="email" type="email" placeholder="Email*" title="Email*"> </span> </div> <div id="count" class="row two-part"> <span class="input-text company" data-manual="1"><input name="company" type="text" placeholder="Company Name*" title="Company Name*"> </span> <div class="dropdown-container"> <div class="dropdown-box" data-char-limit="30" data-scroll-threshold="6" data-highlight-submit=""> <div class="dropdown-title"> <p>Employee Count*</p> </div> <select name="employee_count"> <option value="2">Fewer than 3</option> <option value="24">3 - 24</option> <option value="99">25 - 99</option> <option value="499">100 - 499</option> <option value="999">500 - 999</option> <option value="1000">1000+</option> </select> </div> </div> </div> <div id="contact" class="row"> <div class="dropdown-container style=" width: 423px ""> <div class="dropdown-box" data-char-limit="30" data-scroll-threshold="2" data-highlight-submit=""> <div class="dropdown-title"> <p>Contact</p> </div> <select name="call_time"> <option value="daytime">Daytime</option> <option value="nighttime">Nighttime</option> </select> </div> </div> </div> <ul id="spanish" class="misc"> <li> <label class="checkbox has-orange-fg"> <input type="checkbox" name="spanish">I'm proficient in Spanish</label> </li> </ul> <div id="interested" class="captioned-list"> <p>I'm interested in:</p> <span style=" font-size: 12px; font-family: proximanovaregular; display: block; margin: 10px 0 7px 0; ">Select all that apply</span> <ul> <li> <div class="checkbox-holder"><label class="checkbox" data-manual="1"><input name="w_option_1" type="checkbox" value="Accident"> 事故</label> </div> </li> <li> <div class="checkbox-holder"><label class="checkbox" data-manual="1"><input name="w_option_2" type="checkbox" value="Cancer"> 癌症</label> </div> </li> <li> <div class="checkbox-holder"><label class="checkbox" data-manual="1"><input name="w_option_3" type="checkbox" value="Dental"> Dental</label> </div> </li> </ul> </div> <p class="required-legend"> *Indicates required field </p> <p class="required-legend" style="font-size: 10px; line-height: 12px;"> By hitting "提交" Button I agree to receive autodialed calls and texts from Aflac, independent contractors acting on Aflac’s behalf, and third parties acting on Aflac’s behalf, including but not limited to Five9 at the number I have provided. Messages and data rates may apply. I understand that I am not required to provide my consent as a condition of accessing Aflac’s website, purchasing any product or receiving any Aflac services. </p> </div> </form> </div> </div> <div class="progress-nav"> <a class="back" href="#">Back</a> <a class="next" href="#">Next</a> <a class="submit" href="#">提交</a> </div> </form> </div> <div class="complete-panel"> <div class="thanks"> <div class="title">Thank You!</div> <p> An Aflac representative will contact you. </p> </div> <!-- <div class="info"> <!-- <p> Your confirmation number is <span class="number"></span>. </p <p>If you have any questions regarding your request, contact us at <a class="textlink" href="mailto:addbenefits@aflac.com">addbenefits@aflac.com</a></p> <p>Please provide your confirmation number listed above for reference.</p> </div> <div class="progress-nav"> <a href="" class="next">View Products</a> </div> --> </div> </div> </div> </div> </script> <script id="contact-lightbox-agents-tpl" type="text/html"> <div class="w_contact-lightbox-agents"> <div class="lightbox-content"> <div class="info-section"> <div class="top header-only"> <h6>Apply Now</h6> </div> <div class="middle bottom-aligned"> </div> </div> <div class="form-section"> <a class="close is-grey" href="#">关</a> <div class="form-panel"> <form method="POST"> <div class="form-fields"> <div class="row two-part"> <span class="input-text" data-manual="1"> <input name="firstname" type="text" placeholder="First Name*" title="First Name*"> </span> <span class="input-text" data-manual="1"> <input name="lastname" type="text" placeholder="Last Name*" title="Last Name*"> </span> </div> <div class="row three-part"> <span class="input-text zipcode" data-manual="1"> <input name="zipcode" type="tel" placeholder="ZIP Code*" title="ZIP Code*"> </span> <span class="input-text phone" data-manual="1"> <input name="phone" type="tel" placeholder="Phone*" title="Phone*"> </span> <span class="input-text" data-manual="1"> <input name="email" type="email" placeholder="Email*" title="Email*"> </span> </div> <div class="row"> <div class="dropdown-box date-dropdown" data-manual="1" data-scroll-threshold="5"> <div class="dropdown-title"> <p>How did you hear about us?*</p> </div> <select name="referer" id="referer"> <option value="V">Aflac.com</option> <option value="M">Career Builder</option> <option value="F">Career Fair</option> <option value="G">College Campus Recruiting</option> <option value="1">CareerCo</option> <option value="JB">Glassdoor</option> <option value="K">Google</option> <option value="X">Indeed</option> <option value="5">Monster</option> <option value="P">Online Advertisement </option> <option value="R">Print Advertisement </option> <option value="A">Referral/Nomination</option> <option value="2">Simply Hired</option> <option value="8">Social Media</option> <option value="C">TV Ad</option> </select> <input type="hidden" name="subscriberIdList" value="*=15584|NY=16082"></input> </div> </div> <div class="row"> <span class="input-text" data-manual="1"> <input name="agentnumber" type="text" placeholder="Referring Agent's Number" title="Referring Agent's Number"> </span> </div> <div class="row two-part resume_section"> <!-- <input type="button" class="textbutton is-orange resume upload_resume" value="Upload Resume" />--> <input type="hidden" class="filename" name="filename"/> <input type="hidden" class="fileextension" name="fileextension"/> <input type="hidden" class="filedata" name="filedata"/> <label class="resume_button main_form_resume"> UPLOAD RESUME <input type="file" class="resume_file hidden" accept=".doc,.docx,.txt,.pdf,.rtf,.odt,.wps"/> </label> <label class="resume_label main_form_resume"> No file selected </label> </div> <ul class="misc"> <li> <label class="checkbox has-orange-fg"><input type="checkbox" name="spanish"/> I'm proficient in Spanish</label> </li> <li> I'm over 18 <label class="checkbox"><input type="checkbox" name="over18"/> Yes<span class="ipad-hitfield"></span></label> <label class="checkbox"><input type="checkbox" name="notover18"/> No<span class="ipad-hitfield"></span></label> </li> </ul> </div> <p class="required-legend"> *Indicates required field </p> <div class="progress-nav"> <a class="submit" href="#">提交</a> </div> </form> </div> <div class="complete-panel"> <div class="thanks"> <div class="title">Thank You!</div> <p> You will be contacted soon by one of our Aflac coordinators. </p> </div> <div class="info"> <p> Questions? Email us at <a class="textlink" href="mailto:whyaflac@aflac.com">whyaflac@aflac.com</a> </p> </div> </div> </div> </div> </div> </script> <script id="contact-lightbox-employers-tpl" type="text/html"> <div class="w_contact-lightbox-employers"> <div class="lightbox-content"> <div class="info-section"> <div class="top"> <h6 class="has-subtitle">Offer Aflac <br> <span class="is-smaller">to your employees</span></h6> <p><strong>Aflac policies are 100% employee-paid.</strong> </p> <p>Companies choose to make Aflac policies available to increase benefits options without impacting their bottom line. </p> </div> <div class="middle"> <p>Fill out our <strong>Contact Form</strong> and we'll call you <em>or</em> Call Us now at <a href="tel:855.502.3522">855.502.3522</a></p> </div> <!--<div class="bottom"> <a class="customer-support" href="#">Customer support <br><span class="is-smaller">for existing customers</span></a> </div>--> </div> <div class="form-section"> <ol class="progress-indicator"> <li class="is-current">1. Getting Started</li> <li>2. Contact Information</li> </ol> <a class="close" href="#">关</a> <div class="form-panel"> <div class="form-steps"> <div class="form-step getting-started" data-di-form-track data-di-form-id="business-form-prequalification"> <form action="" method="POST"> <div class="legend"> Provide the following information about your company. </div> <div class="form-fields"> <div id="individualsproductsonly"> <p><a class="textlink" href="/individuals/default.aspx">Learn about individual policies.</a><br> For companies with fewer than three employees, please check out our individual and family coverage. <a class="textlink" href="/individuals/default.aspx">Learn more.</a></p> </div> <div class="row two-part"> <div class="dropdown-box" data-manual="1" data-scroll-threshold="5"> <div class="dropdown-title"> <p>Employee Count</p> </div> <select name="employeecount"> <option value="2">Fewer than 3</option> <option value="24">3 - 24</option> <option value="99">25 - 99</option> <option value="499">100 - 499</option> <option value="999">500 - 999</option> <option value="1000">1000+</option> </select> </div> <span class="input-text" data-manual="1"> <input name="business" type="text" placeholder="Business Name" title="Business Name"> </span> </div> <div class="captioned-list"> <p>I'm interested in:</p> <span style="font-size: 12px; font-family: proximanovaregular; display: block; margin: 10px 0 7px 0;">Select all that apply</span> <ul> <li> <label class="checkbox" data-manual="1"> <input name="b2c" type="checkbox" value="b2c"> Coverage for myself</label> </li> <li> <label class="checkbox" data-manual="1"> <input name="b2b" type="checkbox" value="b2b"> Coverage for my employees</label> </li> <input name="findout" type="hidden" value="Find best option" /> </ul> <!-----END PREQUAL-----> </div> </div> <p class="required-legend"> All fields are required. </p> </form> </div> <div class="form-step contact-info" data-di-form-track data-di-form-id="business-form-contact-info"> <form action="/url_to_post_to" method="POST"> <input type="hidden" name="language" value="EN"> <input type="hidden" name="marketing_program_id" value=""> <div class="legend"> Please provide us with your direct business contact information. </div> <div class="form-fields"> <div class="row two-part"> <span class="input-text" data-manual="1"> <input name="firstname" type="text" placeholder="First Name*" title="First Name*"> </span> <span class="input-text" data-manual="1"> <input name="lastname" type="text" placeholder="Last Name*" title="Last Name*"> </span> </div> <div class="row two-part"> <span class="input-text phone" data-manual="1"> <input name="phone" type="tel" placeholder="Phone*" title="Phone*"> </span> <span class="input-text ext" data-manual="1"> <input name="ext" type="tel" placeholder="Ext." title="Ext."> </span> <span class="input-text zipcode" data-manual="1"> <input name="zipcode" type="tel" placeholder="ZIP Code*" title="ZIP Code*"> </span> </div> <div class="row"> <span class="input-text" data-manual="1"> <input name="email" type="email" placeholder="Email*" title="Email*"> </span> </div> <ul class="misc"> <li> <label class="checkbox" data-manual="1"> <input name="add" type="checkbox"> I currently offer Aflac and would like to add more policies.</label> </li> <!--<li> <label class="checkbox" data-manual="1"><input name="news" type="checkbox"> I'd like to receive the latest Aflac new and insights.</label> </li>--> </ul> </div> <p class="required-legend" style="margin-bottom: 10px;"> *Indicates required field </p> <p class="required-legend" style="font-size: 10px; line-height: 12px;"> By hitting "提交" I agree to receive autodialed calls and texts from Aflac, independent contractors acting on Aflac’s behalf, and third parties acting on Aflac’s behalf, including but not limited to Five9 at the number I have provided. Messages and data rates may apply. I understand that I am not required to provide my consent as a condition of accessing Aflac’s website, purchasing any product or receiving any Aflac services. </p> </form> </div> </div> <div class="progress-nav"> <a class="back" href="#">Back</a> <a class="next" href="#">Next</a> <a class="submit" href="#">提交</a> </div> </div> <div class="complete-panel"> <div class="thanks"> <div class="title">Thank You!</div> <p> An Aflac representative will contact you. </p> </div> <div class="info"> <p> Your confirmation number is <span class="number"></span>. </p> <p> If you have any questions regarding your request, contact us at <a class="textlink" href="mailto:addbenefits@aflac.com">addbenefits@aflac.com</a></p> <p>Please provide your confirmation number listed above for reference.</p> </div> <div class="progress-nav"> <a href="" class="next">View Products</a> </div> </div> </div> </div> </div> </script> <script id="contact-lightbox-brokers-tpl" type="text/html"> <div class="w_contact-lightbox-brokers"> <div class="lightbox-content"> <div class="info-section"> <div class="top header-only"> <h6>Partner with Aflac</h6> </div> <div class="middle bottom-aligned"> Fill out the form and we’ll contact you. <a href="tel:800.992.3522">800.992.3522</a> </div> </div> <div class="form-section"> <a class="close is-grey" href="#">关</a> <div class="form-panel"> <form method="post"> <div class="form-fields"> <div class="row two-part"> <span class="input-text" data-manual="1"> <input name="full_name" type="text" placeholder="Your Name" title="Your Name*"> </span> <span class="input-text" data-manual="1"> <input name="company_name" type="text" placeholder="Broker/Company" title="Broker/Company*"> </span> </div> <div class="row"> <span class="input-text" data-manual="1"> <input name="email_address" type="email" placeholder="Email" title="Email*"> </span> </div> <!-- <div class="row"> <span class="input-text" data-manual="1"> <input name="address_line_1" type="text" placeholder="Address" title="Address*"> </span> </div> --> <div class="row two-part"> <span class="input-text zipcode" data-manual="1"> <input name="zipcode" type="tel" placeholder="ZIP Code" title="ZIP Code*"> </span> <span class="input-text phone" data-manual="1"> <input name="phone_number" type="tel" placeholder="Phone" title="Phone*"> </span> </div> <!-- Original location of email --> <!-- <div class="row"> <span class="input-text" data-manual="1"> <input name="email_address" type="text" placeholder="Email" title="Email*"> </span> </div> <div class="row"> <span class="textarea"> <textarea name="email_message" placeholder="Email Message"></textarea> </span> </div> </div>--> <p>I'm interested in:</p> <ul class="interest-list"> <li> <div class="checkbox-holder"> <label class="checkbox" data-manual="1"> <input name="w_option_1" value="Expanding my current voluntary portfolio" type="checkbox"> Expanding my current voluntary portfolio</label> </div> </li> <li> <div class="checkbox-holder"> <label class="checkbox" data-manual="1"> <input name="w_option_2" value="Offering voluntary policies" type="checkbox"> Offering voluntary policies</label> </div> </li> <li> <div class="checkbox-holder"> <label class="checkbox on-lightbox" data-manual="1"> <input name="w_option_3" value="Getting a Wingman in my office" type="checkbox" id="wingman_tip"> Getting a Wingman in my office</label> </div> </li> </ul> <!-- <div style="display: none" class="w_infobox-popup tool-tip lightbox"><div class="box"><div class="title">What is a Wingman?</div><div class="message">An experienced voluntary expert right in your office – at no cost to you.</div></div></div> --> <!-- <p class="required-legend"> //* Indicates required field </p>--> <!-- <label class="checkbox has-orange-fg" data-manual="1"><input name="optin" type="checkbox"> Opt-in to the latest news and insights</label> --> <p class="required-legend"> All fields are required. </p> <div class="progress-nav"> <input class="submit" type="submit" value="Submit" /> </div> <input name="WcoFormId" type="hidden" value="8ba8b49c-29ee-4c3b-af17-362ddb9795cf" /> </div> </form> </div> <div class="complete-panel"> <div class="thanks"> <div class="title">Thank You!</div> <p> Your message has been successfully sent. </p> </div> </div> </div> </div> </script> <script id="customer-support-lightbox-tpl" type="text/html"> <div class="w_customer-support-lightbox"> <div class="lightbox-content"> <div class="form-section"> <a class="close is-grey" href="#">close</a> <div class="form-panel"> <h6>Customer Support</h6> <p> Fill out this <strong>contact form</strong> </p> <div class="form-fields"> <form name="custSupportForm" action="" method="post"> <input name="WcoFormId" type="hidden" value="" /> <div class="row two-part"> <span class="input-text" data-manual="1"> <input name="first_name" type="text" placeholder="First Name*" title="First Name*"> </span> <span class="input-text" data-manual="1"> <input name="last_name" type="text" placeholder="Last Name*" title="Last Name*"> </span> </div> <div class="row two-part"> <span class="input-text" data-manual="1"> <input name="company_name" type="text" placeholder="Business Name*" title="Business Name*"> </span> <span class="input-text" data-manual="1"> <input name="account_number" type="text" placeholder="Account Number" title="Account Number"> </span> </div> <div class="row two-part"> <span class="input-text" data-manual="1"> <input name="city" type="text" placeholder="City*" title="City*"> </span> <div class="dropdown-box state-dropdown" data-manual="1" data-scroll-threshold="5"> <div class="dropdown-title"> <p>State*</p> </div> <select name="state"> <option value="AL">AL</option> <option value="AK">AK</option> <option value="AZ">AZ</option> <option value="AR">AR</option> <option value="CA">CA</option> <option value="CO">CO</option> <option value="CT">CT</option> <option value="DE">DE</option> <option value="DC">DC</option> <option value="FL">FL</option> <option value="GA">GA</option> <option value="GU">GU</option> <option value="HI">HI</option> <option value="ID">ID</option> <option value="IL">IL</option> <option value="IN">IN</option> <option value="IA">IA</option> <option value="KS">KS</option> <option value="KY">KY</option> <option value="LA">LA</option> <option value="ME">ME</option> <option value="MD">MD</option> <option value="MA">MA</option> <option value="MI">MI</option> <option value="MN">MN</option> <option value="MS">MS</option> <option value="MO">MO</option> <option value="MT">MT</option> <option value="NE">NE</option> <option value="NV">NV</option> <option value="NH">NH</option> <option value="NJ">NJ</option> <option value="NM">NM</option> <option value="NY">NY</option> <option value="NC">NC</option> <option value="ND">ND</option> <option value="OH">OH</option> <option value="OK">OK</option> <option value="OR">OR</option> <option value="PA">PA</option> <option value="PR">PR</option> <option value="RI">RI</option> <option value="SC">SC</option> <option value="SD">SD</option> <option value="TN">TN</option> <option value="TX">TX</option> <option value="UT">UT</option> <option value="VI">VI</option> <option value="VT">VT</option> <option value="VA">VA</option> <option value="WA">WA</option> <option value="WV">WV</option> <option value="WI">WI</option> <option value="WY">WY</option> </select> </div> <span class="input-text zipcode" data-manual="1"> <input name="zipcode" type="text" placeholder="Zipcode*" title="Zipcode*"> </span> </div> <div class="row two-part"> <span class="input-text" data-manual="1"> <input name="email_address" type="text" placeholder="Email*" title="Email*"> </span> <span class="input-text phone" data-manual="1"> <input name="phone_number" type="text" placeholder="Phone*" title="Phone*"> </span> <span class="input-text ext" data-manual="1"> <input name="phone_number_ext" type="text" placeholder="Ext." title="Ext."> </span> </div> <div class="row"> <span 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          从立博体育新消息| 查看通知 打开一个对话框 关闭X 驳回警报通知

          我们提供各种各样的附加员工福利,其中包括:

          • 现场儿童保育设施
          • 现场急救中心和员工健康诊所
          • 健身中心和步行道
          • 健康普查
          • 员工折扣计划
          • 教育奖学金

          除了主要的医疗保险,我们还提供:

          • 牙科保险
          • 短期残疾和长期残疾保险
          • 人寿保险
          • 灵活的支出占
          • 员工援助计划

          招收对象为员工立博体育保险政策包括:

          • 癌症
          • 医院重症监护
          • 医院坐月子赔偿
          • 指定的公共卫生事件
          • 事故
          • 志愿团体定期寿险(VGTL)

          立博体育贡献了一个员工地价为基本人身意外伤害,癌症和医院分娩赔偿和医院的重症监护计划的100%。一些立博体育策略包含每年的健康效益。

          立博体育为员工提供了一个401(k)计划,100%匹配到他们的工资(受IRS限制)和其他财政奖励的4%。此外还有年终红利奖金为所​​有员工的潜力,以及卓越的性能和任期奖励。