EMPLOYER GROUP INFORMATION
Multiple Locations *
Payroll Frequency *
Payroll Deduction Frequency *
Integrated with Payroll? *
Currently Use Self Billing *
How is Open Enrollment Conducted? *
Are New Hires Enrolled When Eligible? *
How are New Hires Enrolled *
EMPLOYEE BENEFITS CURRENTLY OFFERED
Please check "Yes" if the benefits below are currently offered. Otherwise, check "No". If you would like a proposal for a specific benefit please check "Request Proposal".
NOTE: Please make sure you select an answer for each benefit. Your form won't submit if an answer to a benefit is missing.
Basic life *
Voluntary/Supplemental life *
Whole life *
Basic short-term disability *
Voluntary short-term disability *
Basic long-term disability *
Voluntary long-term disability *
Critical illness *
Accident insurance *
Hospital indemnity *
Employee assistance plan *
Which Forester services would the group be interested in? *
Please email all in-force plan designs, rates, census, and broker commission requests to email@example.com.
ALL FIELDS ARE REQUIRED. IF YOUR FORM DOES NOT SUBMIT, YOU MAY HAVE MISSED AN ANSWER ABOVE. CHECK THE FORM AND RESUBMIT.