New Case Opportunity
Discovery Checklist

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

Need help?

Contact:

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

* Fields required.

    YOUR EMAIL

    INSURANCE CARRIER INFORMATION

    BROKER INFORMATION

    EMPLOYER GROUP INFORMATION

    Multiple Locations *

    PAYROLL INFORMATION

    Payroll Frequency *

    Payroll Deduction Frequency *

    BENEFIT ADMINISTRATION

    Integrated with Payroll? *

    Currently Use Self Billing *

    ENROLLMENT METHOD

    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".

    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 *

    VALUE ADDED SERVICES:

    Which value added services would the group be interested in? *

    ADDITIONAL NOTES:

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