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Vantage Flex, LLC
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Services
Install a POP Plan
Install Flex Plan
Install HRA Plan
Install Combo Plan
Install 132 Plan
Install Dental Plan
Install Vision Plan
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Install a POP Plan
To install a plan, please complete the following form. Once you have submitted it to our office, you will be contacted to verify your order.
Company Name
*
EIN
*
Address
*
City
*
State
*
Zip
*
Contact Name
*
Phone Number
*
Email Address
Fax
Principal Office Location (State)
*
Start Date
*
End Date
*
Effective Date
*
Organization Type
Corporation
S Corporation
Limited Liability Company
Professional Corporation
Partnership
Government Entity
Non-Profit Organization
Class of Eligible Employee
Same as Group Health Plan
All Employees
Salaried Employees
Hourly Employees
Service Period Requirements
90 Days after hire
60 Days after hire
30 Days after hire
Date of Hire
Other
Entry Date
Date Requirements are met
First pay period following requirements
First day of the month following requirements
Benefits Coordinator
*
Core Health Insurance Company Name
Non-Core Health Insurance Benefits
Group Term Life Insurance
Disability Insurance
Dental Insurance
Cancer Insurance
Vision Insurance
AD&D Insurance
Prescription Drug Coverage
Other Insurance Coverage
Group Term Life Insurance Company Name
Is the employer subject to FMLA
Yes
No
Is an HSA provided by the employer
Yes
No
Notes
Agent Name
Agent Phone Number
Quoted Annual Fee
Quoted Monthly Fee
Do not enter anything in this field:
*
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Please fill this field.
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