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Thank you for your interest in HealthPlan Services.
Please complete the form below for more information. You may also call 877-506-2164.
My Contact Information
*First Name
*Last Name
*Email Address
Title
Address
City
State
ZIP
Phone Number
I would like to:
Discuss how HPS can help my organization.
Schedue a web demonstration.
Receive future Healthcare Reform updates.
Schedule an onsite meeting.
Receive informational materials about HPS.
About My Organization
Organization Name:
Current Total Enrollment:
a) 1 million+
d) 100,000 - 249,999
b) 500,000 - 999,999
e) 50,000 - 99,999
c) 250,000 - 499,999
f) Less than 50,000
Projected Total Enrollment:
a) 1 million+
d) 100,000 - 249,999
b) 500,000 - 999,999
e) 50,000 - 99,999
c) 250,000 - 499,999
f) Less than 50,000
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
Comments:
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