Get Proposal from MedLion Clinic

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Estimated time: 5 minutes. Complete this form to receive a proposal + savings estimate.

Mobile phone (we will text any questions) *

Contact name *

Employer/Group Name: *

Expected Rollout Date *

YYYY

Insurance Type *

# of Individual contracts *

# of Individual + Spouse contracts *

# of Individual + Child(ren) contracts *

# of Family contracts *

% of contracts in PPO/HMO plans *

% of contracts in HDHP plans *

PCP Co-pay (avg) *

Total # of eligible FTEs *

# of FTEs enrolled in medical plan *

Total # of PTEs/contractors (if applicable)

States with employees (list all) *

Would you like to get a quote for a Medical Plan with embedded MedLion Clinic? *

Yes

Broker/Consultant Name & Email (if any)

Submit

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