We would be pleased to provide a proposal for our brokerage and benefits consulting services to your company. To contact an MBI broker/consultant for a services proposal call:

804.285.1155 (Richmond local) or
800.948.1709 (toll-free)
or e-mail us at:
contact@managedbenefits.com

You can also call us or e-mail us a note (at the address above) to begin the process of obtaining competitive plan designs and rates for your current employee benefit programs. A broker/consultant will be happy to walk you through the information needed to market your plans.

The forms below can be used as a guide for the information that will be required to market your employee benefit plans. If you wish, you can complete these forms now and e-mail them to us to start the process. We’ll contact you promptly. Or, just give us a call.

1. Benefit Plan Proposal Request Form
If you wish, complete and e-mail this form to MBI at contact@managedbenefits.com.

2. Employee Census
Insurance carriers require an employee census in order to provide benefit plan proposals and rates for your company. Please attach to your e-mail an employee census in an Excel or Word document, or, download the Census form and attach it. Please include an employee census with your quest for Benefit Plan Proposal when you e-mail it to Managed Benefits, Inc.

Include the following in your Census form:

• Employee name or number
• Sex
• Date of Birth
• Occupation
• Date of Hire
• Salary
• Type of health coverage (Employee, Emp+Spouse, Emp+Child, Emp+Children, Family)
• Home Zip Code
• COBRA participants identified (or note number of)

3. Group Risk Questionnaire
Health insurance carriers frequently require a “Group Risk Questionnaire” as part of underwriting and pricing initial rates (rates are never final until enrollment is complete). The Risk Questionnaire simply asks if the group administrator is aware of certain health conditions within the group that the carrier deems significant.

The form provided above is a generic Risk Questionnaire. If you wish to complete this and return it to MBI with your census, MBI staff will be able to start the actual carrier risk forms for you, and then consult briefly with you to complete the carrier forms for your signature.