Apply To Be A Health Plan Hero

HEALTH PLAN HERO APPLICATION

Please 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

FIRST

LAST

Title

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.