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Contact Form
Thank you for your interest in HealthPlan Service.
Complete the form below for further assistance. You may also call 877-506-2164.
My Contact Information (*Required)
*First Name
*Last Name
*Email Address
Title
Address
City
State
ZIP
Phone Number
I would like to:
Further discuss how HPS can help my organization. Please contact me.
Receive more information. Please send me literature.
Schedue a web demonstration. Please contact me.
Schedule an onsite meeting. Please contact me.
About My Organization
Organization Name
Current Total Enrollment
a) 1 million+
d) 249,999 - 100,000
b) 999,999 - 500,000
e) 99,999 - 50,000
c) 499,999 - 250,000
f) Less than 50,000
Projected Total Enrollment
a) 1 million+
d) 249,999 - 100,000
b) 999,999 - 500,000
e) Less than 50,000
c) 499,999 - 250,000
About Our Needs
Markets of Interest
Group
Individual
Voluntary
Type of Solution
a) Health Plan
b) Exchange
c) Association
Solutions of Interest
a) Consumer Portal
g) Quoting
m) Billing/Financial Services
b) Broker Portal
h) Underwriting
n) Exchanges/Gov't Integration
c) Sales/Sales Support
i) Eligibility/Enrollment
o) Commissions
d) Distribution
j) Susidy Determination
p) Claims
e) Marketing/Member Outreach
k) Policy Issuance
q) Retention
f) Rating
l) Inforce Administration/Member Services
I will be ready to make a purchasing decision in:
a) Less than 3 months
d) 12+ months
b) 3 - 6 months
e) Do not know
c) 6 - 12 months
Question / Comments