Apply To Be A Health Plan Hero HEALTH PLAN HERO APPLICATIONPlease complete the form below to begin the application process. Once we receive your information, we will contact you with the next steps in the application process.Not ready to apply, but have a question? Email us. Health Plan Hero Application Name * Name FIRST FIRST LAST LAST Title * Email * Phone * Company Name * Company Website * Number of Employees Eligible for Health Plan * Number of Employees * I have read the Evaluation Criteria and believe that our plan will be competitive on the basis of the criteria. (Note: it is okay if you are not sure about some of the criteria.) * I AGREE How is your company plan funded? * Fully Insured Self-Funded/Level-Funded Please describe briefly why your health plan is heroic. If you are human, leave this field blank. Submit Δ