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Benefits Counselor
About

Services
Technology
- Ben Admin Technology
- FMC Two Way Text
Who We Serve
Benefits Counselor
About

New Case Discovery Checklist – Broker

New Case Opportunity
Discovery Checklist - Broker

Use this form to submit a new case opportunity to Forester Benefits Management.

Need help?

Contact:

Email: sales@foresterbenefits.com
Phone: (866) 229-6048

* ALL FIELDS REQUIRED. ALL FIELDS MUST BE ANSWERED OR THE FORM WILL NOT SUBMIT.

Broker Name

Broker Company Name

Broker Email

Broker Mobile Phone

EMPLOYER GROUP INFORMATION

Employer Group Name

Industry Type

# of Eligible Employees

Employer Group Location City and State

Multiple Locations

Yes No

States Located In

Payroll Provider

Payroll Frequency

Weekly Bi-weekly Semi-monthly Monthly

Payroll Deduction Frequency

Weekly Bi-weekly Semi-monthly Monthly

Are all employees on the same payroll calendar/frequency or multiple calendars?

Multiple Calendars Same Calendar

Benefit Plan Year

Ben Admin Platform

Integrated with Payroll?

Yes No

Currently Use Self Biling?

Yes No

How is Open Enrollment Conducted?

Onsite Enrollers Call Center Self-enroll online Self-enroll paper

Does the employer currently offer voluntary employee benefits?

Yes No

Are voluntary benefits offered to new employees upon hiring?

Yes No, only during open enrollment

How are New Hires Enrolled?

Onsite Enrollers Call Center Self-enroll online Self-enroll paper

What benefits do you currently offer?

Basic Life Voluntary/Supplemental Life AD&D Whole Life Basic Short-Term Disability Voluntary Short-Term Disability Basic Long-Term Disability Voluntary Long-Term Disability Critical Illness Accident Insurance Hospital Indemnity Medical Dental Vision HRA HSA FSA Employee Assistance Plan Pet Insurance Pre-Paid Legal Services Identity Theft

Request Proposal:

Basic Life Voluntary/Supplemental Life AD&D Whole Life Basic Short-Term Disability Voluntary Short-Term Disability Basic Long-Term Disability Voluntary Long-Term Disability Critical Illness Accident Insurance Hospital Indemnity Pet Insurance Pre-Paid Legal Services Identity Theft

Which Forester services would the group be interested in?

Ben Admin Platform Open Enrollment Support Onsite Enrollers Call Center Support New Hire/QLE Enrollment Support FMC Texting Solution Benefit Communication Dedicated Open Enrollment Website Pet Insurance Pre-Paid Legal Services Identity Theft Forester Resolve – Decision Support platform

ADDITIONAL NOTES

Any additional information you'd like to provide or would be helpful for us to know?

Please email all in-force plan designs, rates, census, and broker commission requests to sales@foresterbenefits.com.

ALL FIELDS ARE REQUIRED. IF YOUR FORM DOES NOT SUBMIT, YOU MAY HAVE MISSED AN ANSWER ABOVE. CHECK THE FORM AND RESUBMIT.

Broker Information

Broker Name

Broker Company Name

Broker Email

Broker Mobile Phone

Employer Group Info

EMPLOYER GROUP INFORMATION

Employer Group Name

Industry Type

# of Eligible Employees

Employer Group Location City and State

Multiple Locations

Yes No

States Located In

Payroll Info

Payroll Provider

Payroll Frequency

Weekly Bi-weekly Semi-monthly Monthly

Payroll Deduction Frequency

Weekly Bi-weekly Semi-monthly Monthly

Are all employees on the same payroll calendar/frequency or multiple calendars?

Multiple Calendars Same Calendar

Ben Admin

Benefit Plan Year

Ben Admin Platform

Integrated with Payroll?

Yes No

Currently Use Self Biling?

Yes No

Enrollment Method

How is Open Enrollment Conducted?

Onsite Enrollers Call Center Self-enroll online Self-enroll paper

Does the employer currently offer voluntary employee benefits?

Yes No

Are voluntary benefits offered to new employees upon hiring?

Yes No, only during open enrollment

How are New Hires Enrolled?

Onsite Enrollers Call Center Self-enroll online Self-enroll paper

Employee Benefits Offered

What benefits do you currently offer?

Basic Life Voluntary/Supplemental Life AD&D Whole Life Basic Short-Term Disability Voluntary Short-Term Disability Basic Long-Term Disability Voluntary Long-Term Disability Critical Illness Accident Insurance Hospital Indemnity Medical Dental Vision HRA HSA FSA Employee Assistance Plan Pet Insurance Pre-Paid Legal Services Identity Theft

Request Proposal:

Basic Life Voluntary/Supplemental Life AD&D Whole Life Basic Short-Term Disability Voluntary Short-Term Disability Basic Long-Term Disability Voluntary Long-Term Disability Critical Illness Accident Insurance Hospital Indemnity Pet Insurance Pre-Paid Legal Services Identity Theft

Forester Services

Which Forester services would the group be interested in?

Ben Admin Platform Open Enrollment Support Onsite Enrollers Call Center Support New Hire/QLE Enrollment Support FMC Texting Solution Benefit Communication Dedicated Open Enrollment Website Pet Insurance Pre-Paid Legal Services Identity Theft

ADDITIONAL NOTES

Any additional information you'd like to provide or would be helpful for us to know?

Please email all in-force plan designs, rates, census, and broker commission requests to sales@foresterbenefits.com.

ALL FIELDS ARE REQUIRED. IF YOUR FORM DOES NOT SUBMIT, YOU MAY HAVE MISSED AN ANSWER ABOVE. CHECK THE FORM AND RESUBMIT.

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