BenefitsSURF

HOW MANY FULL-TIME EMPLOYEES DO YOU HAVE? HOW MANY FULL-TIME EMPLOYEES DO YOU HAVE? 0-20 21-50 51-100 101-300 300+

Select Employer Location Select Employer LocationAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelewareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingD.C. (Other U.S.A)Foreign Territory

DO YOUR EMPLOYEES RESIDE IN MORE THAN ONE LOCATION (MULTI-STATE)? DO YOUR EMPLOYEES RESIDE IN MORE THAN ONE LOCATION (MULTI-STATE)? Yes No

HOW MANY OTHER LOCATIONS (STATES)? HOW MANY OTHER LOCATIONS (STATES)? One (1) Two (2) Three (3) Four (4) or More

Select Out-of-State Location Select Out-of-State LocationAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelewareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingD.C. (Other U.S.A)Foreign Territory

Include other employee locations (e.g. Texas, New York)

WHAT TYPE OF MEDICAL PLAN DO YOU OFFER? WHAT TYPE OF MEDICAL PLAN DO YOU OFFER? Single-Carrier HMO Single-Carrier PPO Single-Carrier HMO/PPO Multi-Carrier HMO/PPO None (OTHER)

Select Medical Carrier Select Medical CarrierAetnaAnthemBCBSBlue ShieldCignaHealth NetCal ChoiceCignaCovered CAHealth NetHumanaKaiserOscarProminenceSharpSierra/HPNUnitedNone (OTHER)

Select Other Carrier Select Other CarrierAetnaAnthemBCBSBlue ShieldCignaHealth NetCal ChoiceCignaCovered CAHealth NetHumanaKaiserOscarProminenceSharpSierra/HPNUnitedNone (OTHER)

HOW MANY EMPLOYEES ARE ENROLLED (%)? HOW MANY EMPLOYEES ARE ENROLLED (%)? less than 25% 25% - 50% 50% - 75% 75% - 100% N/A

FREE VALUE-ADDS INCLUDED FREE VALUE-ADDS INCLUDED Find A Doctor Televisits Wellness Discounts Mobile App