Template:Json Request Insurance

              {
                   companyName: "companyName",
                   phoneNumber: "phoneNumber",
                   address1: "address1",
                   address2: "address2",
                   city: "city",
                   state: "state",
                   zip: "zip",
                   policyNumber: "policyNumber",
                   groupNumber: "groupNumber",
                   planName: "planName",
                   groupName: "groupName",
                   effectiveDate: "effectiveDate",
                   expirationDate: "expirationDate",
                   guarantorRelationship: "guarantorRelationship",
                   guarantorName: "guarantorName",
                   guarantorFirstName: "guarantorFirstName",
                   guarantorMiddleName: "guarantorMiddleName",
                   guarantorLastName: "guarantorLastName",
                   guarantorDob: "guarantorDob",
                   guarantorGender: "guarantorGender",
                   copayAmount: "copayAmount"
              }