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My Benefits Channel

My Benefits Channel

Streamline the Employee Life Cycle

  • Solutions
    • Employee Life Cycle Management
      • Hiring
      • Onboarding
      • HR
      • Benefits
      • Documents
      • Wellness
      • Time
      • Pay Stubs
      • Training
      • Compliance
      • Offboarding
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MyBenefitsChannel Quote Request – DCP

This field is for validation purposes and should be left unchanged.

Who is completing this form?

Name*

Distribution Channel Partner Contact Person for Implementation

Is the DCP Contact for Implementation the same as the person completing this form?*
Name of DCP Contact Person for Implementation*
Include DCP Contact Person in communications with Customer re: Implementation?*

Customer Information

Address*
Customer Type*
This should be the 1st of a month
Send Agreement for Signature to*

Payroll/HR Vendor Information

Payroll/HR Functionality Currently Used
Please describe the current payroll/HR functionality (e.g., vendor, capabilities, etc.)
Other vendors currently used:

Benefits Administration Information

Will Customer be using Selerix for enrollment?*

Carrier Partner for Selerix

Will MBC be responsible for building out the case in Selerix?

Implement MBC before Enrollment?

Selected MyBenefitsChannel Apps

In this section, please indicate the apps and services the customer wants to purchase NOW. You will have the opportunity to indicate what the customer is not purchasing, but is interested in learning more about later in the form.
Benefits Package includes: Onboarding, Benefits, Wellness Essentials, Compliance (SaaS), Offboarding, and MyTaskManager
HR Package includes: Onboarding, HR, Training, Offboarding, and MyTaskManager
Premium Package includes the following modules: Onboarding, HR, Benefits, Wellness Essentials, Pay Stubs, Training, Compliance (SaaS), Offboarding, and MyTaskManager
Base Package Selected by Customer*
Add-on Apps and Services Selected by Customer*
These are apps they ARE purchasing now.
Hiring Add-on Apps and Services Selected by Customer
Compliance Add-on Apps and Services Selected by Customer
Benefits & Wellness Add-on Apps and Services Selected by Customer
Time & Attendance Add-on Apps and Services Selected by Customer

Customer Also Interested In…

Add-on Apps and Services Customer is Interested In*
These are apps they are NOT purchasing now, but would like to learn more about. Please provide detail below.

Implementation Contacts and Information

Implementation Contacts*
Provide at least one customer contact for implementation. Add additional rows as necessary.
Name
Title
Email
Apps Responsible for
 
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Phone
(615) 791-0404
(800) 435-5023

Email
info@mybenefitschannel.com

Solutions

  • Employee Life Cycle Management
  • Advisory Services

Resources

  • ACA Compliance
  • Onboarding
  • HR Glossary

Company

  • About Us
  • Contact Us
  • Our Customers
  • Be a Partner
  • Security
  • Careers
SOC 2 – Type II AICPA

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