Request for Proposal (OLD)

Last Page

Broker Details

Brokerage Name *

Broker Representative Details

First Name
Last Name
Broker Email
Broker Phone Number

Group Details

Group Name
Current client since
Benefit Renewal Date
First Deduction Date for the Plan Year

Benefit Eligible Employee Census

Total # of benefit eligible employees
Approximate # Employees Currently Enrolled in Medical Plan

Part-Time or Variable Hour Employees Census

Is the client interested in special benefits for part-time or variable hour employees?
Total # of Part-Time and Variable lives?


Number of Locations
States in Which Locations/Employees Exist

Communication & Enrollment

Enrollment Type
Desired Benefit Counslor Support
Check all that apply.
What languages need to be supported? (comma separated)
Benefits to Enroll
Current platform or method used for enrollment today
Is the client interested in changing their enrollment platform?
Would the client like to consider using our enrollment platform?

Benefit & Technology Administration

Current HRIS / Payroll System Vendor
Does the client current EDI's or API's set up for core linves of coverage?
Does the group have a budget set for technology?
If, yes, what is their budget?

What enhanced services are important along with a BenAdmin solution?

Employee Advocacy & Support

Goals & Success

Client's current pain points
goals of this process
anything unique about the client we should know?
Target date for a decision by the client?
What should we focus on delivering to make this a successfor you?

Additional Needed Info

Stay Connected

4551 W. 107th Street
Overland Park, KS 66207
(877) 523-0176
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Hammond Office

1201 Derek Drive
Hammond, LA 70403
(877) 365-2341
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Jackson Office

2935 N Highland Ave
Jackson, TN 38305
(877) 365-2341
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Clearwater Office

2650 McCormick Drive
Clearwater, FL 33759
(877) 523-0176
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Dallas Office

5 Cowboys Way, Suite 300
Frisco, TX 75034
(214) 315-5560
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Thank you for your interest

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