Group Insurance Marketplace Feasibility Evaluation

Please tell us a little about yourself and your agency:

    Your Name (required)

    Your Email (required)

    Your Phone (required)

    Your Company Name

    Have you ever implemented an online enrollment system for a client?:

    YesNo

    Do you currently offer an online marketplace technology solution to your clients?:

    YesNo

    If you have a specific employer in mind, please answer these additional questions below:

    What type of client is this?:

    Existing clientProspect

    Number of employees:

    Employer industry (examples: "manufacturing, transportation..."):

    Estimated annual turnover percentage:

    When do the employer's benefits renew next?:

    In which state does the employer have their headquarters?:

    Does the client or prospect have multiple divisions, branches, or locations?:

    YesNo

    Does this employer currently offer an online benefits marketplace to employees?:

    YesNo