Coordinator Assistance

Coordinator Assistance

Client / Enrollment Basics (Page 2/5)
Billing Control # (BCN)
Commission Account # (CAN)
New Hire Waiting Period*
Eligibility Requirements*
Coverage Effective Date*

MonthDayYear
Date
Pay Periods*

WeeklyBiweekly (Every other week)Semi-Monthly (Twice a month)Monthly
Premium Effective Date

MonthDayYear
Date
1st Deduction Date

MonthDayYear
Date
Enrollment Start Date*

MonthDayYear
Date
Enrollment End Date*

MonthDayYear
Date
Location States*
Locations*
Shifts*

Coordinator Assistance

Enrollment Conditions (Page 4/5)
Enrollment Marketing

Youville/WebsiteDigital PostcardsMailers/Payroll StuffersCalendly/SchedulerPosters
Enrollment Details (Be as specific as possible)*
1x1 Follow-Up Type*

Active (We see Everyone)Passive (Optional)
Will we have the WiFi Password?*

YesNo - Bring a Hotspot
Other Notes (Bi-lingual, Dress Code...)