ICHRA REFERRAL to LS Benefits

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Your Name (Agent)* This field is required.
First Name
Last Name
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Your Email (Agent)* This field is required.
jdoe@voluntarypartners.com
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Your Phone Number (Agent)* This field is required.
Area Code
Phone Number
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Referred COMPANY Name:* This field is required.
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Decision Maker's Name* This field is required.
First Name
Last Name
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Decision Maker's Phone Number* This field is required.
Area Code
Phone Number
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Decision Maker's Email* This field is required.
example@example.com
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GREAT NEWS {yourName}!

Here's what's in it for you.

LS Benefits has agreed to REQUIRE {decisionMakers} from {referredCompany} to budget $40/month/employee for an EMPLOYER SPONSORED Assurity Hospital Plan (HI) to offset the cost of the employee's deductibles/IUAs. LS is required to use due diligence with this process and procedure setting this up for you.

Note: It is your role and duty to enroll the HI plan with each employee, offer it to their families as well AND offer other VB plans. This set's you up perfectly for an essentials package at a minimum.

Additionally, You will receive a Split on all Sedera/Tru Health Packages offered rather than a referral fee. Tracking of this is your responsibility. Completing this form will send Brian Leen (LS Benefits), Julie Silverman (Sedera/Tru Health), you, and your Executive Partner a notification of this agreement and referral.
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What is the biggest priority for them when offering a health plan to the employees?
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Do they currently offer a GROUP Health Insurance Plan?* This field is required.
Yes
No
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How many employees are on this GROUP plan? * This field is required.
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On a scale of 1-10…How close is this company to dropping the Group Health plan because it is deemed “Unaffordable” to the Company?* This field is required.
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Do they offer any type of INDIVIDUAL health plan currently?* This field is required.
Yes
No
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How much emphasis does this company place on offering the best possible health benefits to their employees?* This field is required.
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Upload your complete Census here if you have one.
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Choose your Executive Partner for assistance correspondence* This field is required.
Please Select
Please Select
Alex Sell (CO)
Alex Sell/Treve Rasmussen (CA)
Susan Svarda (OH)
Rick McKinney (AR/OK)
Zach Milwood (TX)
Denise Forconi/Brendan Fox (AZ)
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