you would like details on the voluntary group-related plans available (to
help offset administrative costs), we will be happy to supply you with the
order to do so, please email or fax us a group census consisting of a list
of employees (names and social security numbers are not necessary) with the
Date of Birth?
Date of Hire?
Indicate if the employee is currently insured under your medical plan.
include the following information about your company:
Company Startup Date?
Number of sites and zip codes of employer locations?
What is the primary Business of the company?
Total Number of Employees?
Do you currently have a POP plan?
Do you currently have a Flex plan?
Are voluntary benefits currently offered? (If yes, give details).
What kind of medical plan do you have? (HMO,PPO,Etc.)