SmartConnect Onboarding Profile

First 6 questions MUST be completed prior to client onboarding. The balance of questions are optional, but will help us to better tailor the customer experience journey for eligible employees/members.

* Required

"*" indicates required fields

Step 1 of 4

Who are you?

Name of TPA/Captive*

Consultant Contact

First Name*

Last Name*

Email Address*

Phone

Brokerage Name*

Client Information

Is this organization part of a captive?*

Captive Name*

What is the legal name of your company?*

Where is the company's physical headquarters?*

What is the total employee population headcount?*

What is the total employee population headcount over the age of 64?*

Will you be sharing census data with SmartConnect?*

Yes

Company Logo

Max. file size: 50 MB.

All logos must be a png file that has a transparent background.

Do we have permission to use your company logo in our promotional materials?*

Primary HR Contact Information

Name*

Email*

Phone*

Please upload the employee benefits guide and monthly contributions: PDF Only

Max. file size: 50 MB.

If the file size is to large to upload, please email to partner.connect@smartmatch.com

Please confirm the group's open enrollment period? (if applicable)

When the Medicare eligible employees/members opt out of the group benefits while still actively employed, what group benefits can they keep, if any?

Do you currently offer/provide retirement benefits?

Yes

Maybe

Comments

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