Phone*About the PlanGroup Plan Type*-- Select One --Self-FundedFully InsuredHow many are enrolled in the medical?*How many years have they been self-funding?Which network?Which stop-loss carrier?Which TPA/carrier?Who is your PBM?Medical Management is currently offered for:Please check all that apply.
Utilization management (UM)
Catastrophic Case Management
Do they currently have a wellness program in place?*YesNoPlease elaborate.*Has the plan been successful?What carrier are they currently with?*Which TPA?*Do they have a wellness plan in place?*YesNoDo you offer benefits to dependents relative to wellness, screenings etc.?*YesNoPlease elaborate.*Has the plan been successful?Has the concept of self-funding been presented to them?YesNoHas a wellness program been presented to them?YesNoWhy are they considering a move to self-funding?Do they have any concerns we can address?Are there any key features they are interested in?CaptchaPlease type the characters you see below.
Please check all that apply.