Igoe Administrative Services, FSA & COBRA Administration

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Participants

Employers

Brokers

About Us

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Request For Proposal [RFP]

We created the online proposal tool to allow you to request proposals for your clients quickly and efficiently. The information provided from this questionnaire will allow us to create a proposal that is tailored towards your client’s specific administrative needs. Upon submission of your request, a detailed confirmation e-mail will be sent to the e-mail address provided in the form. A business development team member will be in contact with you upon receipt of this information. We appreciate the opportunity!

* All fields are required unless labled as Optional.

Brokers Info

Company:

Broker Name:

Phone:

Email:

Target Implementation Date:

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Date Proposal is Due:

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Employer Info

	Company Name:
	Company Contact:
	Company Website:

	Number of Benefit Eligible Employees:
	Require separate premium checks or bank accounts:	YesNo
	Multiple Locations:	YesNo

	Number of locations:
	Are benefits administered from a central location:	YesNo

Number of contacts:

Proposed Services ( Select all that apply )

	Spending Accounts
	Flexible Spending Account (FSA):
	Health Savings Account (HSA):
	Health Reimbursement Arrangement (HRA):
	Transportation & Parking:

	COBRA Administration Services
	COBRA Administration:

	Direct Billing
	Extended COBRA Billing:
	Retiree Billing:
	Other:

Spending Account Info

When do insurance contracts renew annually:

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Is this an Existing Plan:

YesNo

	How many current participants:
	Is a Benefits Card currently offered:	YesNo
	Who is your current Flex administrator:
	How many years with current administrator:
	What is the main reason for switching:

COBRA Administration Info

Number of current/enrolled COBRA participants:

Number of pending COBRA participants:

Average number of qualifying events per month:

* The accuracy of this information is vital to
   preparing a custom quote. The proposed
   COBRA fees will be reflective of the information
   you provide, so please make sure to include
   accurate data.

Total number of qualifying events over last 24 months:

Number of COBRA eligible benefit plans:

Does the client use Cal Choice:

* Please Note: Igoe does not provide
administration for Cal Choice

YesNo

When do insurance contracts renew annually:

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