ICHRA REFERRAL to ATMA PMF

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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.

ATMA PMF 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. Mike 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! This is a real win keeping you sticky and secure!
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What is the biggest priority for them when offering a health plan to the employees? And do you have any special notes or requests for ?
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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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Choose your Executive Partner for assistance correspondence* This field is required.
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Please Select
Alfred and Karen Rietkerk - TN/FL
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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