You can always press Enter⏎ to continue
New Case Quote & ExpressEnroll platform request

New Case Quote & ExpressEnroll platform request

Hi there, please fill out and submit this form to get your requested proposal(s) and Case built for you in ExpressEnroll if requested. ALL CASES START HERE
12Questions
  • 1
    -
    Pick a Date
    Press
    Enter
  • 2
    Press
    Enter
  • 3
    If you are NOT using ExpressEnroll, YOU are responsible for the coordination and build directly with the carriers you select.
    Press
    Enter
  • 4
    This helps your case builder ensure you have the latest enrollment version and let's the carrier know that changes are coming. Please be specific.
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 5
    THIS IS NOT YOUR PROSPECT'S INFORMATION, BUT YOURS
    Please Select
    • Please Select
    • FOUNDER'S CIRCLE MEMBER - PARTNER (front of the line)
    • PARTNER with VIP
    • VALUED BROKER that works with VIP
    • Affiliate
    Please Select
    • Please Select
    • CO/CA/MO - Alex Sell, Brendan Fox, Treve Rasmussen or Vanessa Morales
    • OH/LA - Susan Svarda
    • TX/AR/OK - Zach Milwood
    • AZ - Brendan Fox
    Press
    Enter
  • 6
    PART 1
    Yes
    • Please Select
    • Yes
    • No
    Please Select
    • Please Select
    • YES
    • NO
    Press
    Enter
  • 7
    PART 2
    Press
    Enter
  • 8
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
    Press
    Enter
  • 9

    CLICK NEXT TO REVIEW AND ACKNOWLEDGE THE SPECIAL UNDERWRITING  AND MINIMUM ENROLLMENT/EDUCATION CONDITION STANDARDS THAT YOU HAVE AVAILABLE THROUGH VIP.

     

    Press
    Enter
  • 10

    For Groups with 3-249 employees:

    SCROLL and READ THROUGH COMPLETELY BEFORE MOVING FORWARD

    PLEASE REVIEW OUR BeneList Packages, underwriting Standards, Referral Opportunities and choose your offerings:

    Our agency business will be reviewed quarterly to ensure our block of business meets Assurity's overall participation requirements of at least 15%. If VIP fails to meet acceptable participation guidelines, Assurity reserves the right to revoke or modify our underwriting offer, or reject any group, at any time.

    --------------------------------------------------------------------------

    ASSURITY (groups with 3-249):

    Assurity Accident - (2 apps required, Guarantee Issue, 90% EDUCATION and your due diligence is required)

    Assurity Hospital w CI/Cancer - (2 apps required, Guarantee Issue, Waiver of Pre-Existing Conditions for ALL employees at initial enrollment and new hires, 90% EDUCATION and your due diligence is required)

    Assurity Lump Sum CI/Cancer - (2 apps required, Guarantee Issue, Waiver of Pre-Existing Conditions for ALL employees at initial enrollment and new hires, 90% EDUCATION and your due diligence is required)

    Assurity Disability - (2 apps required, Guarantee Issue) (Waiver of Pre-Ex available on TAKEOVER ONLY with a 6% load)

    Assurity GROUP TERM LIFE - (Groups 3-9) - Minimum participation requirement of 3 applications. Always simplified issue up to $50,000.

    Assurity GROUP TERM LIFE - (Groups 10-249) - (The greater of 5 apps or 10% of the employee count on the Master App required, Guarantee Issue up to 100k!)

    -------------------------------------------------------------------------------

    DENTAL/VISION PACKAGE (groups with 3-249)

    Beam Dental/Vision 3-50 lives (Your State's Shelf Rates - 2 apps required)

    Beam Dental/Vision 50+ lives (Custom Rates are required - 2 apps required)

    BEAM EMPLOYER PAID LIFE (optional) (25 or 50k, Census required - not voluntary)

    -------------------------------------------------------------------------------

    VIRTUAL HEALTH PACKAGE (Choose ONE)

    LYRIC TELEHEALTH & EAP w GoLexi Virtual Pet Health- $12/PEPM (2 minimum requirement)

    or

    LYRIC COMPLETE VIRTUAL PRIMARY CARE, $0 Copay Acute Prescriptions, Virtual Urgent Care, Wellness Labs, Virtual Urgent Care, EAP, and GoLexi Virtual Pet Health - $65/PEPM (2 minimum requirement)

    -------------------------------------------------------------------------------

    PERMANENT LIFE (Groups with 5+)

    5Star Life Term to age 121 with LIVING BENEFITS for LTC Needs - (5 min enrolled requirement, Guarantee Issue up to 100k!)

    -------------------------------------------------------------------------------

    MEDICAL INSURANCE REFERRAL

    LS Benefits Group - will Handle everything for your client regarding Sedera, TruHealth DPC, and ICHRA (and more) and split commissions to you! Be GREAT at VOLUNTARY and stay stickier and more profitable. This is the EASIEST way to do more with less risk.

    -------------------------------------------------------------------------------

    HUMAN INTEREST 401k REFERRAL

    HUMAN INTEREST 401K is the EASY BUTTON to offer affordable 401k Solutions to your client! $100 for a set appointment from them and another $300 for a closed referral!

    -------------------------------------------------------------------------------

    HEARTLAND PAYROLL& HR SOLUTIONS REFERRAL

    HEARTLAND PAYROLL Can relieve the HR and Payroll headaches for your clients. Stay sticky without letting the fox in your henhouse!

    Press
    Enter
  • 11

    For Groups with 250+ employees:

    SCROLL and READ THROUGH COMPLETELY BEFORE MOVING FORWARD

    PLEASE REVIEW OUR BeneList Packages, underwriting Standards, Referral Opportunities and choose your offerings:

    --------------------------------------------------------------------------

    Assurity Accident - Custom Underwriting approval required

    Assurity Hospital w CI/Cancer - Custom Underwriting approval required

    Assurity Disability - Custom Underwriting approval required

    Assurity GROUP TERM LIFE - Custom Underwriting approval required

    Assurity Lump Sum CI/Cancer - Custom Underwriting approval required

    -------------------------------------------------------------------------------

    Beam Dental - (CUSTOM RATE QUOTES REQUIRED - 2 apps required)

    Beam VSP Vision - (CUSTOM RATE QUOTES REQUIRED - 2 apps required)

    BEAM EMPLOYER PAID LIFE - (25 or 50k, Census required - not voluntary)

    -------------------------------------------------------------------------------

    LYRIC TELEHEALTH & EAP w GoLexi Virtual Pet Health- $12/PEPM (2 minimum requirement)

    or

    LYRIC COMPLETE VIRTUAL PRIMARY CARE, $0 Copay Acute Prescriptions, Virtual Urgent Care, Wellness Labs, Virtual Urgent Care, EAP, and GoLexi Virtual Pet Health - $65/PEPM (2 minimum requirement)

    -------------------------------------------------------------------------------

    5Star Life Term to age 121 w Living Benefits - (15% enrolled requirement, Guarantee Issue)

    -------------------------------------------------------------------------------

    MEDICAL INSURANCE REFERRAL

    LS Benefits Group - will Handle everything for your client regarding Sedera, TruHealth DPC, and ICHRA (and more) and split commissions to you! Be GREAT at VOLUNTARY and stay stickier and more profitable. This is the EASIEST way to do more with less risk.

    -------------------------------------------------------------------------------

    HUMAN INTEREST 401k REFERRAL

    HUMAN INTEREST 401K - is the EASY BUTTON to offer affordable 401k Solutions to your client! $100 for a set appointment from them and another $300 for a closed referral!

    -------------------------------------------------------------------------------

    HEARTLAND PAYROLL& HR SOLUTIONS REFERRAL

    HEARTLAND PAYROLL - Can relieve the HR and Payroll headaches for your clients. Stay sticky without letting the fox in your henhouse!

    Press
    Enter
  • 12
    By initialing I acknowledge that VIP requires that 10% of the group size on every LOB offered and 15% of the group size is required for Life Insurance. I understand that in order to protect our underwriting, VIP reserves the right to turn down any enrollment below this minimum standard.
    Clear
    Press
    Enter
  • 13
    All.proposals will be built monthly so invoicing is correct on the backend.
    Press
    Enter
  • 14
    Press
    Enter
  • 15
    Press
    Enter
  • 16
    We STRONGLY recommend only offering one elimination and one benefit period - Less is MORE.
    Press
    Enter
  • 17
    Unless in a competitive situation please use Shelf Rates in cases sized 3-49. This helps keep our renewal increases lower in the long haul. We currently have a 2 year rate lock with a 5% cap.
    Press
    Enter
  • 18
    Press
    Enter
  • 19
    Press
    Enter
  • 20
    Please mark all referrals that you intend to send. We will email you the links for the referral forms that are required.
    Press
    Enter
  • 21
    THIS IS for disability TAKEOVERS only. You MUST provide a CURRENT and up to date invoice with all current disability policyholders. We already have a Waiver of Pre-Ex included for Hospital and Critical Illness.
    Press
    Enter
  • 22
    By initialing I acknowledge that this is a TAKEOVER and NOT a Coexistence. I understand that this is an underwriting privilege that I have through VIP, and I will maintain the highest ethical standards.
    Clear
    Press
    Enter
  • 23
    Press
    Enter
  • 24
    This is required for a takeover and waiver of existing policyholder's pre-existing conditions
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
    Press
    Enter
  • 25
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • Should be Empty:
Question Label
1 of 25See AllGo Back
close