Validate( $_POST['Carrier'], 'Carrier_msg', '' ); $Validator->Validate( $_POST['BrokerName'], 'BrokerName_msg', '' ); $Validator->Validate( $_POST['BrokerAddress'], 'BrokerAddress_msg', '' ); $Validator->Validate( $_POST['Email'], 'Email_msg', '' ); $Validator->Validate( $_POST['NameOfInsured'], 'NameOfInsured_msg', '' ); $Validator->Validate( $_POST['DoingBusinessAs'], 'DoingBusinessAs_msg', '' ); $Validator->Validate( $_POST['LocationAddress'], 'LocationAddress_msg', '' ); $Validator->Validate( $_POST['MailingAddress'], 'MailingAddress_msg', '' ); $Validator->Validate( $_POST['City'], 'City_msg', '' ); $Validator->Validate( $_POST['State'], 'State_msg', '' ); $Validator->Validate( $_POST['Zipcode'], 'Zipcode_msg', '' ); $Validator->Validate( $_POST['EffectiveDate'], 'EffectiveDate_msg', '' ); //$Validator->Validate( $_POST['TotalNumberOfFemales'], 'TotalNumberOfFemales_msg', '' ); //$Validator->Validate( $_POST['TotalNumberOfMales'], 'TotalNumberOfMales_msg', '' ); $Validator->Validate( $_POST['ModeOfPayment'], 'ModeOfPayment_msg', '' ); $Validator->Validate( $_POST['FederalID'], 'FederalID_msg', '' ); $Validator->Validate( $_POST['NatureOfBusiness'], 'NatureOfBusiness_msg', '' ); $Validator->Validate( $_POST['EmployeeContribution'], 'EmployeeContribution_msg', '' ); $Validator->Validate( $_POST['PreviousCarrier'], 'PreviousCarrier_msg', '' ); $Validator->Validate( $_POST['NewVenture'], 'NewVenture_msg', '' ); $Validator->Validate( $_POST['AdditionalInsuredOrLocations'], 'AdditionalInsuredOrLocations_msg', '' ); $Validator->Validate( $_POST['Contact'], 'Contact_msg', '' ); $Validator->Validate( $_POST['Telephone'], 'Telephone_msg', '' ); // 'submitform' does not has captcha field // $Validator->recaptchaValidate( $_POST['recaptcha_challenge_field'], $_POST['recaptcha_response_field'], 'Captcha_msg' ); // Check Validation Status // $IsSuccess = $Validator->getSuccess(); $IsSuccess = true; // Passed Validation if( $IsSuccess ){ $Carrier = $_POST['Carrier']; // First Rebilitation $Enriched = $_POST['enriched']; $Rehab_Amount = $_POST['amount_rehab_field']; $In_Hospital = $_POST['inhospital']; $ADD_Rider = $_POST['add_rider']; //Guardian $Guardian_Amount = $_POST['amount_guardian_field']; $Another_Line = $_POST['another_line']; //Standard Security $Percent_Plan = $_POST['percent_plan']; $Std_Sec_Amount = $_POST['amount_std_sec']; $Monthly_Rate = $_POST['monthly_rate']; $BrokerName = $_POST['BrokerName']; $BrokerAddress = $_POST['BrokerAddress']; $Email = $_POST['Email']; $NameOfInsured = $_POST['NameOfInsured']; $DoingBusinessAs = $_POST['DoingBusinessAs']; $LocationAddress = $_POST['LocationAddress']; $MailingAddress = $_POST['MailingAddress']; $City = $_POST['City']; $State = $_POST['State']; $Zipcode = $_POST['Zipcode']; $EffectiveDate = $_POST['EffectiveDate']; $TotalNumberOfFemales = $_POST['TotalNumberOfFemales']; $TotalNumberOfMales = $_POST['TotalNumberOfMales']; $ModeOfPayment = $_POST['ModeOfPayment']; $FederalID = $_POST['FederalID']; $NatureOfBusiness = $_POST['NatureOfBusiness']; $EmployeeContribution = $_POST['EmployeeContribution']; $PreviousCarrier = $_POST['PreviousCarrier']; $NewVenture = $_POST['NewVenture']; $AdditionalInsuredOrLocations = $_POST['AdditionalInsuredOrLocations']; $Contact = $_POST['Contact']; $Telephone = $_POST['Telephone']; $enriched_coverage = $_POST['enriched']; $standard_security_percent_plan = $_POST['standard_security_percent_plan']; $standard_security_amount = $_POST['standard_security_amount']; //$standard_security_monthly_rate = $_POST['standard_security_monthly_rate']; $guardian_amount = $_POST['guardian_amount']; $guardian_add_another_line = $_POST['guardian_add_another_line']; $first_rehab_amount = $_POST['first_rehab_amount']; $first_rehab_inhospital = $_POST['first_rehab_inhospital']; $first_rehab_add_rider = $_POST['first_rehab_add_rider']; $first_rehab_add_rider_amt = $_POST['first_rehab_add_amt']; $zurich_amount = $_POST['zurich_amount']; $EnrichedCoverage = ''; if( $Carrier == "Zurich" ){ $to = "info@dblcntr.com,dblapp@zurichna.com"; if( isset( $enriched_coverage ) && $enriched_coverage == 'Yes' ) { $EnrichedCoverage = " Enriched Coverage: Yes Amount: $$zurich_amount"; } else { $EnrichedCoverage = " Enriched Coverage: No"; } }elseif ( $Carrier == "Standard Security" ){ $to = "info@dblcntr.com,dblcenterapps@sslicny.com,cboyd@sslicny.com "; if( isset( $enriched_coverage ) && $enriched_coverage == 'Yes' ) { $EnrichedCoverage = " Enriched Coverage: Yes Plan: $standard_security_percent_plan % Amount: $$standard_security_amount"; } else { $EnrichedCoverage = " Enriched Coverage: No"; } }elseif ( $Carrier == "Hartford" ){ $to = "info@dblcntr.com,statutory.disability@thehartford.com"; }elseif ( $Carrier == "Guardian" ){ $to = "info@dblcntr.com,dsaltzman@aristacorp-tpa.com"; if( isset( $enriched_coverage ) && $enriched_coverage == 'Yes' ) { $EnrichedCoverage = " Enriched Coverage: Yes Amount: $$guardian_amount Adding Another Line: $guardian_add_another_line"; } else { $EnrichedCoverage = " Enriched Coverage: No"; } }elseif ( $Carrier == "ShelterPoint Life Insurance" ){ $to = "info@dblcntr.com,mnegron@firstrehab.com"; if( isset( $enriched_coverage ) && $enriched_coverage == 'Yes' && isset( $first_rehab_add_rider_amt ) ) { $EnrichedCoverage = " Enriched Coverage: Yes Amount: $$first_rehab_amount In Hospital: $first_rehab_inhospital AD&D Rider: $first_rehab_add_rider AD&D Rider Amount: $$first_rehab_add_rider_amt"; } elseif( isset( $enriched_coverage ) && $enriched_coverage == 'Yes' && !isset( $first_rehab_add_rider_amt ) ) { $EnrichedCoverage = " Enriched Coverage: Yes Amount: $$first_rehab_amount In Hospital: $first_rehab_inhospital AD&D Rider: $first_rehab_add_rider"; } else { $EnrichedCoverage = "Enriched Coverage: No"; } }elseif ( $Carrier == "Presidential" ){ $to = "info@dblcntr.com,Presidential_Life_Admin@bpi-tpa.com"; }else{ $to = "info@dblcntr.com"; } //$to = 'michael@unce.us'; //$to = $to . ',mscottcohen@gmail.com'; $from = "From: $Email"; $subject = "Insurance Wholesaler -NY State Pooled Form Submission"; $body = " $EnrichedCoverage Carrier: $Carrier Broker Name: $BrokerName Broker Address: $BrokerAddress Email: $Email Name Of Insured: $NameOfInsured Doing BusinessAs: $DoingBusinessAs Location Address: $LocationAddress Mailing Address: $MailingAddress City: $City State: $State Zipcode: $Zipcode Effective Date: $EffectiveDate Total Number Of Females: $TotalNumberOfFemales Total Number Of Males: $TotalNumberOfMales Mode Of Payment: $ModeOfPayment Federal ID: $FederalID Nature Of Business: $NatureOfBusiness Employee Contribution: $EmployeeContribution Previous Carrier: $PreviousCarrier New Venture: $NewVenture Additional Insured Or Locations: $AdditionalInsuredOrLocations Contact: $Contact Telephone: $Telephone "; // Send PHP Email mail( $to, $subject, $body, $from ); // Send confirmation email mail( $Email, $subject, $body, $from ); } } else if( isset( $_POST['submitform2'] ) ) { $Validator->recaptchaValidate( $_POST['recaptcha_challenge_field'], $_POST['recaptcha_response_field'], 'Captcha_msg' ); // Check Validation Status $IsSuccess = $Validator->getSuccess(); if ($IsSuccess) { $emailTo = "info@dblcntr.com"; $fName = $_POST['fnameInput']; $lName = $_POST['lnameInput']; $emailaddress = $_POST['emailInput']; $message = $_POST['messageInput']; $subject2 = "Insurance Wholesaler - NY State Pooled Forgot Login Credentials"; $body2 = "The user has forgotten their login credentials, First Name: $fName Last Name: $lName Email: $emailaddress message: $message"; // Send PHP Email mail( $emailTo, $subject2, $body2, $emailaddress ); } } ?> Disability Benefits Law New York, New York Disability Benefits, NY DBL.

Insurance Wholesaler

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< Return to NY state pooled rates

New York State DBL Pooled Rates

To Bind Coverage for Under 50 Lives*

Select a Carrier below to get started:
  Company Rating Quarterly Male/Female Monthly Proprietor Coverage Annual inAdvance
/> AMTrust Group A $2.90/M
$6.35/F
$9.50 $19.80/M
$45.00/F
data-premium-requirement="Minimum Premium Requirement for ShelterPoint Life Insurance = $125" data-minimum-premium="125" data-male-quarterly-cost="2.4" data-female-quarterly-cost="5.1" data-male-annually-cost="23.4" data-female-annually-cost="51" onClick="_gaq.push(['_trackEvent', 'Insurance Carrier', 'Application Process', 'first rehab']);" /> ShelterPoint Life A- $2.15/M
$4.60/F
$1.75/Male $3.80/Female $21.00/M
$45.60/F
data-premium-requirement="Minimum Premium Requirement for Guardian = $60" data-minimum-premium="60" data-male-quarterly-cost="2.6" data-female-quarterly-cost="5.75" data-male-annually-cost="23.16" data-female-annually-cost="53.88" onClick="_gaq.push(['_trackEvent', 'Insurance Carrier', 'Application Process', 'Guardian']);" /> Guardian A++ $2.60/M
$5.75/F
$6.85 $23.16/M
$53.88/F
data-premium-requirement="Minimum Premium Requirement for Hartford = $45" data-minimum-premium="45" data-male-quarterly-cost="2.19" data-female-quarterly-cost="4.47" data-male-annually-cost="21.36" data-female-annually-cost="49.68" onClick="_gaq.push(['_trackEvent', 'Insurance Carrier', 'Application Process', 'Hartford']);" /> Hartford A $2.19/M
$4.47/F
$10.50 $21.36/M
$49.68/F
data-premium-requirement="Minimum Premium Requirement for Standard Security = $60" data-minimum-premium="60" data-male-quarterly-cost="1.50" data-female-quarterly-cost="3.30" data-male-annually-cost="18.00" data-female-annually-cost="39.60" onClick="_gaq.push(['_trackEvent', 'Insurance Carrier', 'Application Process', 'Standard Security']);" /> Standard Security A- $1.50/M
$3.30/F
$9.36 $18.00/M
$39.60/F

*All community rates are subject to carriers minimum premium.

Contact us for the commission you receive directly from the carriers above.

Please click here to see a list of our Group Ancillary Carriers for Life/AD&D, LTD, STD, Dental & Vision.

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All Fields Required Otherwise State N/A

Click here to get started.

AmTrust offers an electronic process that will allow you to submit your application in realtime. This process will enable you to receive approved policies. The DBL Center thanks you for selecting AmTrust.

If you need assistance with any Statutory quotes for over or under 50 lives click here to see a list of our staff members in each department.

Click here to get started.
No Logins Required to bind New DBL Applications.

ShelterPoint offers an electronic process that will allow you to submit your application in realtime. This process will enable you to receive approved policies and remit payments online.

The DBL Center thanks you for selecting ShelterPoint Life. Please Click Here to login to issue Certificates of Insurance and View Your Book of Business!

If you need assistance with any Statutory quotes for over or under 50 lives click here to see a list of our staff members in each department.

/> Yes   /> No
Download New York Enriched DBL Products from Zurich (PDF)
2x $340
3x $510
4x $680
5x $850
Download New York Enriched DBL Products from ShelterPoint Life Insurance (PDF)
1.5x $255
2x $340
3x $510
4x $680
5x $850
  • In Hospital
  • /> Yes
  • /> No
  • AD&D Rider
  • /> Yes
  • /> No
  •  
  • /> 25K
  • /> 50K
Download New York Enriched DBL Products from Guardian (DOC) Enter Dollar Amount ($250 / $500 / $700)
  •  
  • Adding Another Line
  • /> Yes
  • /> No
Download New York Enriched DBL Products from Standard Security Life (PDF)
  • /> 50% Plan ($200-$500 - $50 increments)
  • /> 60% Plan ($200-$350 - $50 increments)
  • Enter Dollar Amount

 



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Forgot your login credentials?

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Last name

Email

Message

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The D.B.L. Center LTD. issues their community rated, under 50 life DBL applications electronically in real time. It is fast and easy.

Simply select a carrier above by clicking on it, fill out the appropriate fields and click submit. Your application was bound directly with the insurance company of your choice and a copy was sent to your agency and ours for a system of checks and balances guaranteeing your policy was bound.

If you need assistance with any Statutory quotes for over or under 50 lives click here to see a list of our staff members in each department.


Have questions?

Call (800) 325-2777 or email us today!