• Skip to primary navigation
  • Skip to main content
  • Skip to footer
My Benefits Channel Logo

My Benefits Channel

Streamline the Employee Life Cycle

MENUMENU
  • Solutions
    • Employee Life Cycle Management
      • Hiring
      • Onboarding
      • HR
      • Benefits
      • Wellness
      • Time
      • Pay Stubs
      • Training
      • Compliance
      • Offboarding
    • Advisory Services
  • Why We’re Different
  • Company
    • About Us
    • Contact Us
    • Our Customers
    • Be A Partner
    • Security
    • SOC 2
    • Careers
  • Store
    • Featured Products
    • Downloads
    • View Cart
  • Webinars
  • Login
  • Request a demo

Quote Request

Complete the form below to request a quote for Online Enrollment and/or Benefits Administration.

  • Who is completing this form?

  • Who should the quote be sent to?

  • Prospect/Customer Information

  • Benefits Administration Information

  • MM slash DD slash YYYY
  • Case Set-up Details

    Please provide the estimated counts as directed below. Set-up fees will apply for changes made to these estimates after initial set-up. If a carrier partner is responsible for building certain products DO NOT include them in the counts below.
  • Provide the number of plans for each benefit type. Example: a dental plan with a high/low option would count as 2 plans.
    MedicalDentalVisionAncillary/Voluntary 
  • Provide the number of rate sets for each benefit type. Example: if the group has 3 classes of employees and 2 dental plans, that's 6 total rate sets.
    MedicalDentalVisionAncillary/Voluntary 
  • Provide the number of formats for each benefit type. If you only need the standard report format and nothing customized, enter 0.
    MedicalDentalVisionAncillary/Voluntary 
  • Provide the number of formats for each benefit type. If you only need the standard report format and nothing customized, enter 0.
    MedicalDentalVisionAncillary/Voluntary 
  • Provide the number of forms for each benefit type. Forms are custom presentations needed inside of the enrollment system. This is rarely used.
    MedicalDentalVisionAncillary/Voluntary 
  • What else should we know about this enrollment? For example, will a carrier partner be responsible for building some of the products?
  • This field is for validation purposes and should be left unchanged.

Footer

Solutions

  • Employee Life Cycle Management
  • Advisory Services

Store

  • Featured Products
  • Downloads
  • Cart

Company

  • About Us
  • Contact Us
  • Our Customers
  • Be A Partner
  • Security
  • Careers
  • Why We’re Different
  • Webinars
  • Login
  • Request a demo
My Benefits Channel Logo

Phone
(615) 791-0404
(800) 435-5023

Email
info@mybenefitschannel.net

Copyright © 2023 My Benefits Channel - All Rights Reserved.
Created by Web Design Franklin TN

Privacy Policy   |   Terms   |   Admin Login