Employers Request for a CareFlex Administrative Services Proposal

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Proposal Request Form for CareFlex Administrative Services

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RFP for CareFlex Administrative Services
Employer's Information
Company Name	Agency name please.
Contact Name	Broker's name please.
Telephone	Telephone number please.Invalid format.
Cell Phone
E-mail	. E-mail address please.Invalid format.
Target Implementation Date
Date Proposal is Due
Company Website	URL please.Invalid format.
Number of Benefit Eligible Employees	Number of eligible employees please.

Proposed Plans (please select all that apply)
Section 125 Premium Only Plan
Is this an existing plan?	Yes No

FSA Account Information
Is this an existing plan?	Yes No
How many current participants?		Is a benefits card offered?	Yes No

HRA Account Information
Is this an existing plan?	Yes No
How many current participants?		Is a benefits card offered?	Yes No

HSA Account Information
Is this an existing plan?	Yes No
How many current participants?		Is a benefits card offered?	Yes No

Transportation & Parking Account Information
Is this an existing plan?	Yes No
How many current participants?		Is a benefits card offered?	Yes No

Additional Comments


CareFlex Benefit Solutions 205 West Dares Beach Road • Prince Frederick, MD 20678 Phone: (888)577-2762 (dot) • FAX: (410)414-8432 Email: questions@careflex.com	Site Map ©CareFlex, 2009. All rights reserved. Website Design by Oasis Grafx.