*

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Current Plan *

Do you use a PEO?

Section 125

Group Health

Both Section 125 and Group Health

Do You Currently Use an HR Consultant? *

Yes

No

Do You Currently Offer Benefits to Your Employees? *

Yes

No

If "YES, you currently offer benefits": Do you feel like you are overpaying on your group health plan? *

Yes

No

For Employers with 100-plus employees on your current health plan: Would you be opposed to us empirically showing how you are overpaying an average of 10-20% each year? *

Yes

No

Do you currently have a health management program for your employees? *

Yes

No

Would You LIke to....(check all that apply) *

Save an average $600-900 per employee per year?

Enhance your employee's benefits?

Optimize your employee's health?

Increase your employee's take-home pay?

Receive all these benefits at NO net cost to you OR your employees?