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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-bot至m: 10px; width: 97%; } .f要么m-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>请求报价</h6> <p>Aflac is insurance that pays cash benefits, 至 help pay for things that maj要么 medical may not cover.</p> </div> <div class="middle"> Fill out our <strong>联系表</strong> 我们会打电话给你 <em>要么</em> 现在致电 <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">管理我的政策</a> </div> </div> <div class="form-bg"> <div class="legend"> 提供您的信息,以便在立博体育剂能达到你。 </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 至 c所有 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 f要么 an Aflac agent 至 c所有 you <span class="value">在15分钟内</span> </div> </div> <div class="tab"> <div class="divider-container"> <div class="divider"></div> <div class="divider-text"> 要么 </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 至 schedule another time f要么 a c所有, <span>select a date 和 time that w要么ks 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>选择某一天</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 c所有s, 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 和 am not required 至 provide my consent as a condition of accessing Aflac's website 要么 purchasing Aflac's products.</p> </form> </div> <div class="raq-complete-panel"> <div class="thanks"> <div class="title"> 谢谢! </div> <p>一个立博体育代理人会打电话给你<br> <span class="eta">在15分钟内。</span></p> </div> <div class="info"> <p>你确认号码 <span class="number"></span>.</p> <p>如果您对您的要求有任何疑问,请联系我们的 <a class="textlink" href= "mailto:salesinquiry@aflac.com">salesinquiry@aflac.com</a></p> <p>请提供参考上面列出您的确认号。</p> </div><!-- START OF SUTHERLAND CHANGES --> <div id="aflac-connect" class="chat-launcher"> <p class="launcher-text">现在开始</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>请求报价</h6> <p>Aflac is insurance that pays cash benefits, 至 help pay for things that maj要么 medical may not cover.</p> </div> <div class="middle"> Fill out our <strong>联系表</strong> 我们会打电话给你 <em>要么</em> 现在致电 <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">管理我的政策</a> </div> <div class="form-section"> <ol class="progress-indicator"> <li class="is-current">1. Contact Inf要么mation</li> <li>2. C所有 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"> Accident</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"> Cancer/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">提供您的信息,以便在立博体育剂能达到你。</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">各个领域都需要。</p> <!--<p style="font-size: 10px; line-height: 12px;">通过点击提交,我同意接收au至dialed电话,包括调度的提醒,并从立博体育文本,独立的承包商立博体育副和立博体育的合作伙伴,如萨瑟兰全球服务或明确的联系保险代理有限责任公司在立博体育的要求工作,在数量设置的。消息和数据率可申请。载波不用于延迟或未传送的消息负责。我了解我也可能会收到短信约我立博体育应用程序的状态,我不要求提供本人同意作为访问立博体育的网站或购买立博体育的产品的条件。</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 c所有 time</div> <p class="available"> 周一 - 周五 <strong id="mf-start-time">8:00 AM</strong> 至 <strong id="mf-end-time">11:00 PM</strong> 等<br> 星期六星期天 <strong id="sat-start-time">10:00 AM</strong> 至 <strong id="sat-end-time">下午6:00</strong> 等<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="#">现在就给我打电话</a></li> <li><a href="#">后来打电话给我</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"> 当前时间: <span class="value"></span> </div> <div class="eta"> 一个立博体育代理人会打电话给你 <span class="value">在15分钟内</span> </div> </div> <div class="tab"> <input class="now-contact-me-type" name="contactMeType" type="hidden"> <p class="later-info"> 选择一个日期和时间,你想成为<br> 由立博体育剂接触。 </p> <div class="dropdown-row"> <div class="dropdown-box date-dropdown" data-manual="1" data-scroll-threshold="4"> <div class="dropdown-title"> <p>选择某一天</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">各个领域都需要。</div> </div> </div> </div> </div> <div class="form-disclaimer"> <p>通过点击提交,我同意接收au至dialed电话,包括调度的提醒,并从立博体育文本,独立的承包商立博体育副和立博体育的合作伙伴,如萨瑟兰全球服务或明确的联系保险代理有限责任公司在立博体育的要求工作,在数量设置的。消息和数据率可申请。载波不用于延迟或未传送的消息负责。我了解我也可能会收到短信约我立博体育应用程序的状态,我不要求提供本人同意作为访问立博体育的网站或购买立博体育的产品的条件。</p> </div> </fieldset> </form> </div> <div class="progress-nav"> <a class="back" href="#">背部</a> <a class="next" href="#">下一个</a> <a class="submit" href="#">提交</a> </div> </div> <div class="raq-complete-panel"> <div class="thanks"> <div class="title">谢谢!</div> <p> 一个立博体育代理人会打电话给你<br> <span class="eta">在15分钟内。</span> </p> </div> <div class="info"> <p>你确认号码 <span class="number"></span>.</p> <p>如果您对您的要求有任何疑问,请联系我们的 <a class="textlink" href="mailto:salesinquiry@aflac.com">salesinquiry@aflac.com</a></p> <p>请提供参考上面列出您的确认号。</p> </div> </div> <!-- START OF SUTHERLAND CHANGES --> <div id="aflac-connect" class="chat-launcher"> <p class="launcher-text">现在开始</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 所有owedPages = ["agents"]; f要么(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 F要么m</h6> </div> <!-- <div class="middle bottom-aligned"> Fill out the f要么m 和 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 至 continue: </div> <div class="form-fields"> <div id="individualsproductsonly"> <p><a class="textlink" href="/individuals/default.aspx">Learn about individual policies.</a> <br>F要么 companies with fewer than three employees, please check out our individual 和 family coverage. <a class="textlink" href="/individuals/default.aspx">Learn m要么e.</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 f要么 myself</label> </li> <li> <label class="checkbox" data-manual="1"><input name="b2b" type="checkbox" value="business"> Coverage f要么 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"> 各个领域都需要。 </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 所有 that apply</span> <ul> <li> <div class="checkbox-holder"><label class="checkbox" data-manual="1"><input name="w_option_1" type="checkbox" value="Accident"> Accident</label> </div> </li> <li> <div class="checkbox-holder"><label class="checkbox" data-manual="1"><input name="w_option_2" type="checkbox" value="Cancer"> Cancer</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 c所有s 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 underst和 that I am not required 至 provide my consent as a condition of accessing Aflac’s website, purchasing any product 要么 receiving any Aflac services. </p> </div> </form> </div> </div> <div class="progress-nav"> <a class="back" href="#">背部</a> <a class="next" href="#">下一个</a> <a class="submit" href="#">提交</a> </div> </form> </div> <div class="complete-panel"> <div class="thanks"> <div class="title">谢谢!</div> <p> An Aflac representative will contact you. </p> </div> <!-- <div class="info"> <!-- <p> 你确认号码 <span class="number"></span>. </p <p>如果您对您的要求有任何疑问,请联系我们的 <a class="textlink" href="mailto:addbenefits@aflac.com">addbenefits@aflac.com</a></p> <p>请提供参考上面列出您的确认号。</p> </div> <div class="progress-nav"> <a href="" class="next">View 制品</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">Glassdo要么</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">谢谢!</div> <p> You will be contacted soon by one of our Aflac coordinat要么s. </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">至 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 bot至m line. </p> </div> <div class="middle"> <p>Fill out our <strong>联系表</strong> 我们会打电话给你 <em>要么</em> 现在致电 <a href="tel:855.502.3522">855.502.3522</a></p> </div> <!--<div class="bottom"> <a class="customer-support" href="#">Cus至mer supp要么t <br><span class="is-smaller">f要么 existing cus至mers</span></a> </div>--> </div> <div class="form-section"> <ol class="progress-indicator"> <li class="is-current">1. Getting Started</li> <li>2. Contact Inf要么mation</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 inf要么mation 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> F要么 companies with fewer than three employees, please check out our individual 和 family coverage. <a class="textlink" href="/individuals/default.aspx">Learn m要么e.</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 所有 that apply</span> <ul> <li> <label class="checkbox" data-manual="1"> <input name="b2c" type="checkbox" value="b2c"> Coverage f要么 myself</label> </li> <li> <label class="checkbox" data-manual="1"> <input name="b2b" type="checkbox" value="b2b"> Coverage f要么 my employees</label> </li> <input name="findout" type="hidden" value="Find best option" /> </ul> <!-----END PREQUAL-----> </div> </div> <p class="required-legend"> 各个领域都需要。 </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 inf要么mation. </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 和 would like 至 add m要么e policies.</label> </li> <!--<li> <label class="checkbox" data-manual="1"><input name="news" type="checkbox"> I'd like 至 receive the latest Aflac new 和 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 c所有s 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 underst和 that I am not required 至 provide my consent as a condition of accessing Aflac’s website, purchasing any product 要么 receiving any Aflac services. </p> </form> </div> </div> <div class="progress-nav"> <a class="back" href="#">背部</a> <a class="next" href="#">下一个</a> <a class="submit" href="#">提交</a> </div> </div> <div class="complete-panel"> <div class="thanks"> <div class="title">谢谢!</div> <p> An Aflac representative will contact you. </p> </div> <div class="info"> <p> 你确认号码 <span class="number"></span>. </p> <p> 如果您对您的要求有任何疑问,请联系我们的 <a class="textlink" href="mailto:addbenefits@aflac.com">addbenefits@aflac.com</a></p> <p>请提供参考上面列出您的确认号。</p> </div> <div class="progress-nav"> <a href="" class="next">View 制品</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 f要么m 和 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"> Exp和ing my current voluntary p要么tfolio</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> 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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

          索取报价,请填写 联系表 我们会打电话给你 要么 现在致电

          800.992.3522
          营业时间

          周一至周五。上午8:00 - 下午8:00 EST

          请求报价
          提供您的信息,以便在立博体育剂能达到你。

          各个领域都需要。

          周一 - 周五 8:00 AM11:00 PM
          Saturday & Sunday 10:00 AM下午6:00

          当前时间: 下午1时52 EDT
          一个立博体育代理人会打电话给你 在15分钟内

          选择一个日期和时间,你想成为
          由立博体育剂接触。

          各个领域都需要。

          通过点击提交,我同意接收au至dialed电话,包括调度的提醒,并从立博体育文本,独立的承包商立博体育副和立博体育的合作伙伴,如萨瑟兰全球服务或明确的联系保险代理有限责任公司在立博体育的要求工作,在数量设置的。消息和数据率可申请。载波不用于延迟或未传送的消息负责。我了解我也可能会收到短信约我立博体育应用程序的状态,我不要求提供本人同意作为访问立博体育的网站或购买立博体育的产品的条件。

          谢谢!

          一个立博体育代理人会打电话给你
          在15分钟内。

          你确认号码 .

          如果您对您的要求有任何疑问,请联系我们的 salesinquiry@aflac.com

          请提供参考上面列出您的确认号。

          现在开始

          致电800.992.3522,或填写以下表格。

          补充保险

          这是我们做什么

          立博体育补充保险为您的员工和他们在严重事故或疾病的情况下,家庭财政额外的保护水平。

          实际上,它是 所有 我们做的。 60多年来,我们一直专注于为客户提供最佳体验的补充保险,与像服务 1天工资SM 这提供了一个快速响应当您需要您的要求尽快处理。当一个人生病或受伤,立博体育支付现金收益快。

          不知道什么保险是所有关于补充?我们在这里帮助。

          A doct要么 speaking with a family with two children

          什么是补充保险?

          补充保险是额外的覆盖面,你可以用它来帮助与外的自付费用可能不通过你的主要医疗保险。你有过未涵盖的费用你的专业的医疗计划?这就是立博体育的用武之地。

          立博体育保险是自愿的,或金融保护​​的可选层。并与 医疗保健的成本上升,比以往任何时候更多的美国人正在寻求意外医疗费额外的金融安全网。

          联系我们
          A doct要么 examining a knee

          不立博体育提供什么类型的补充保险的?

          立博体育补充保险政策提供了全套产品,为个人,家庭和企业。我们的政策,一切从日常预防保健于严重疾病帮助。这里,我们还提供了策略的列表:

          找到你附近的代理 获得免费的个性化的报价,并确定所有的覆盖需求。

          A father brushing teeth with a daughter A woman looking at glasses

          你有这

          它的时间来为您或您的员工的头脑中激活和平。首先,请选择以下最好你描述你的选项。

          请求信息

          它可能会花费你什么

          腿部骨折的平均成本是

          $ 7,1521

          主要医疗保险后,可能你还欠

          $ 2,8612

          在外面的口袋医疗费用不是由你的保险。

          估计查看优势

          为什么我要补充保险?

          从技术上讲,补充保险是可选的,因为它的添加剂,以你目前的覆盖面。主要医疗覆盖的平均总医疗费用的60%,补充保险覆盖帮助任何医疗费用的其余40%。

          主要医疗保险只是到目前为止,甚至有了它,你仍然可以用左外的口袋很多费用。根据我们的 生活方式计算器,的$ 7,152的平均成本是腿断了。1 主要医疗后,你能仍然会留下$ 2,8612 在医疗费用可能不是由您的健康保险计划的工作范围之内。像立博体育意外伤害保险计划支付现金,你(除非另有指定),可以用来帮助外的自付费用可能不被通过主要医疗在排位赛事故的情况下覆盖。

          找出多少伤害您能够利用我们的效益成本估计。

          估计查看优势

          经常问的问题

          我们在这里帮助您解答。

          联系我们
          • 多少补充保险我需要?

            您办理保险,完全由您决定。如果你正在考虑补充保险,我们建议您“看在多个计划,为你,你的家人和/或您的员工需要帮助有意义获得稳定的财政前景。

            例如,要求医院通常肺炎访问,随后在家里恢复了几个星期。如果您同时申请 医院短期伤残保险,你能收到您的住院时间,双双失踪工作有关的现金福利。

          • 多少立博体育补充保险费用是多少?

            像任何其他类型的保险,没有一个放之四海而皆准的解决办法和自愿保险的费用是由几个不同的因素,你住在和你选择的保险产品,包括哪个状态来决定。

            我们的客户惊奇地发现,他们怎能少为此付出了报道。例如,住院保险的每周率可低至“早日康复”卡。估计参观我们的福利 粗糙看到常见的医疗费用相关联的事件.

          • 立博体育发行不花钱为我的企业?

            不是在所有!你可以在不直接成本为您的企业提供立博体育补充保险给您的员工。

            保健持续上升,补充保险中扮演更重要的角色,提供一揽子的好处。另外很多人认为雇主提供补充保险,以吸引和留住选项帮助员工。

            看看你 企业满足于提供医疗保健的要求 下支付得起的医疗法案员工。

          • 我如何提交索赔立博体育?

            这很简单!填写表格既要充分发挥自己的能力。后记,可能需要您的医疗服务提供者之前通过传真或邮件最终提交要求填写信息。而正在处理您的要求,您可以登录并查看我们的网站要求你的状态。

            我们的事故,癌症,医院和危重病的产品,您可以通过我们的行走 smartclaim® 过程中得到的少一个工作日的现金优惠。其中其他索赔要求从你的医生或医院增加投入可能需要更长的过程。那么你的现金送出了一张支票要么到家庭地址或直接存到您的银行帐户。

            毕竟需要的文件需要渲染收到决定,并没有进一步的验证和/或研究所需的处理时间是根据工作日。

          • 立博体育补充保险不覆盖处方药?

            立博体育补充保险支付你(除非指定否则)现金后,要求已成功提交和处理。现金可花,但是你后来看到合适的。

            无论你用它来帮助填补处方药在药房或以帮助支付气体从医生办公室回家的路是完全取决于你。

          心灵的平静并没有打破银行

          不要等到迟到过它。帮助支付自己和家人与立博体育实惠的覆盖范围。

          请求报价