BSI Corporate Benefits Client Work Order

AccountID
BSI Corporate Benefits Client Work Order

Per Master Services Agreement
Today's Date

MonthDayYear
Broker Contact

First NameLast Name
Broker Email
Employer Group or Client Name
The company that will use BenefitsApp for their employees
Client Point of Contact:

First NameLast Name
Client Email
Email to send a work order agreement and NDA.
BenefitsApp Order Form:
Target Launch Date :

MonthDayYear
The launch date is the target date for release to employees.
Estimated Number of Users: (records per census file)
A census may include employee, employee + spouse and/or children over 18. Each user is a member for PMPM.
Invoice or Other Instructions:
Please provide instructions for billing and any other comments related to the client's BenefitsApp. These comments are between Broker and BenefitsApp and not shared with the client contact.
Additional Production and Messaging Fees:
- One Class included. Additional Classes are $500 per class per year.
- Creative Production Management by BenefitsApp: $75/hour (push message development, marketing literature or other) for pre-approved creative production management.
- SMS Fees: 10 messages per member per month included, $0.01 per message after 10 messages.
- Push/In-App Fees: 10 messages per member per month included, $0.01 per message after 10 messages.
If available, please upload the most recent Benefits Guide and additional files for the BenefitsApp.

DO NOT UPLOAD CENSUS DATA HERE.
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By submitting this signed Broker Client Work Order, the BenefitsApp team will review the BenefitsApp specification, and if everything is in order, BenefitsApp will send a Client Agreement with NDA for digital signature to your Client Contact's email.

Upon signature, BenefitsApp will send an Annual Invoice (Annual License + Annual PEPM if that option is checked) to the Accounts Payable Email address. Upon payment, the BenefitsApp team will engage the Client Contact for development and distribution of BenefitsApp to their employee members.
Should be Empty:

BSI Corporate Benefits Client Work Order

BenefitsApp Order Form: