Employee Benefits Discovery Call Request
To book a discovery call with us, please schedule your call, and then provide all the required details. The more information you provide, the more productive our call will be.
Schedule Your Employee Benefits 45 minute Discovery Call
Name
*
First Name
Last Name
Business Name
*
Role
*
Owner, CEO, President, etc.
Contact Number
*
E-mail
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Industry
*
Advertising, Manufacturing, Engineering, Legal Services, etc
# of Full-Time Employees:
*
# of Part-Time Employees:
# of Contract/Variable Hour Employees Employees:
Describe the support are you looking for?
*
Describe the demographics of your employee base. What arethe different roles, functions, geographies, etc.?
How many employees are covered in your current plan and how many total lives do you cover? Do you anticipate this number to increase/decrease in the future?
What are you trying to accomplish with the benefits you offer your employees? How did you come to offer your current health plan?
Who are the key players that may be involved in the decision-making process? Are decisions made by committee, consensus or individual?
Medical Carrier:
*
Write N/A if none
Renewal Date:
*
Write N/A if none
EMPLOYER CONTRIBUTION:
*
Write N/A if none. Ex: 100%, 50%, 0%
What kind of healthcare plans do you currently offer?Describe how you came to offer this plan.
Are you self-insured or fully insured? If self-insured who is your current Third-Party Administrator?:
Write N/A if you don't know
If you are self-insured who is your stop-loss carrier? What kind of contract type are you currently under?
If you are self-insured are you using any additional vendors? If so, who?
Are your employees satisfied with their options? Are there any areas they have identified needs improvement?
Dental Carrier:
*
Write N/A if none
Renewal Date:
*
Write N/A if none
EMPLOYER CONTRIBUTION:
*
Write N/A if none. Ex: 100%, 50%, 0%
Vision Carrier:
*
Write N/A if none
Renewal Date:
*
Write N/A if none
EMPLOYER CONTRIBUTION:
*
Write N/A if none. Ex: 100%, 50%, 0%
Life/AD&D Carrier:
*
Write N/A if none
Renewal Date:
*
Write N/A if none
VoluntaryLife/AD&D Carrier:
*
Write N/A if none
Renewal Date:
*
Write N/A if none
Short Term Disability Carrier:
*
Write N/A if none
Renewal Date:
*
Write N/A if none
EMPLOYER CONTRIBUTION:
*
Write N/A if none. Ex: 100%, 50%, 0%
Long Term Disability Carrier Carrier:
*
Write N/A if none
Renewal Date:
*
Write N/A if none
EMPLOYER CONTRIBUTION:
*
Write N/A if none. Ex: 100%, 50%, 0%
Worksite Benefits Carrier:
*
Write N/A if none
Renewal Date:
*
Write N/A if none
Payroll Vendor
*
# of Payroll Annual Cycles
Ex: 12, 24, 26, 52
Benefits Adminstration and/or HRIS Vendor
*
Write N/A if none
Submit
Should be Empty: