Print

  1. Farm Bureau Member:

    The NEFB Board of Directors has authorized us to investigate the possibility of structuring a health plan that would be available to qualifying Nebraska Farm Bureau members. The goal is to structure a health plan that will secure good coverage at a reasonable premium for our qualifying members. In order to move forward with this option, we need to gather information from our members in order to obtain rating and pricing analysis for a group health insurance product.

    This information will assist us in determining if a group health plan is feasible. Your responses will be treated as confidential and does not include any future obligations.

    Thank you in advance for your assistance on this effort to better serve our members.

    Sincerely,

    Steve D. Nelson
    President - NEFB

    Rob J. Robertson
    Chief Administrator – NEFB


  2. Farm Bureau Member Name(*)
    Invalid Input
  3. Business Name (if applicable)(*)
    Invalid Input
  4. Address(*)
    Invalid Input
    Please provide full address. Ex. 5225 S. 16th St, Lincoln, NE 68512.
  5. County(*)
    Invalid Input
  6. Email Address
    Invalid Input
  7. Phone Number
    Invalid Input
  8. Number of family members and ages (Spouse and children age 25 and under):(*)
    Invalid Information
    Fill in the information
  9. Current family health insurance policy:(*)
    Invalid Input
  10. Other Insurance(*)
    Invalid Input
    (Please describe)
  11. Connection to agriculture (Check all applicable options)(*)




    Invalid Input
  12. Working in agri-business(*)
    Invalid Input
    Please describe
  13. Business structure of farm or ranch (*)
    Invalid Input
  14. Number of employees on farm or ranch: (check all applicable and specify number of non-spouse employees, as applicable)(*)
    Invalid Information
    Fill in the information
  15. At what premium rate would you be interested in group health plan coverage?(*)
    Invalid Information
    Fill in the amount
  16. Which providers would you like to see included in the group health plan network:(*)
    Invalid Information
    Fill in the information