cpr.mymarketlink.comProposal Request

Proposal Type MarketLink Standalone Services (COBRA/Spending Accounts) ACA Standalone Tracking & Reporting Tool MarketLink Solution: 1) MarketLink Solution Type: Benefits Administration 2) Technology or Administration Solutions: - Technology Solutions - available for under 500 eligible employees. - Administration Solutions - available for over 500 eligible employees. Technology Administration Contact Information: 3) HUB: MMA - Florida MMA - Mid-Atlantic MMA - Mid-West MMA - New England MMA - Northeast MMA - SouthWest MMA - Trion MMA - Upper Mid-West MMA - West Mercer MMA - Puerto Rico MMA - Alaska Marsh JCS MMA - SouthEast Non-MMA 4) Agency (i.e. MHBT): 5) Name of Requestor: 6) Requestor Email Address: Company Information: 7) Client Name: 8) Client Address: 9) Client Contact Name: 10) Client Contact Email: 11) Client Contact Phone: (999-999-9999) 12) Total number of active employees: 13) Total number of FT benefit eligible employees: 14) Total number of PT benefit eligible employees: 15) Will non-benefit eligibles employees need to be maintained in the system? Yes No Unknown 16) Renewal Date/Plan Year (s): 17) If multiple plan years, please explain: 18) Requested Go Live Date: (MM/DD/YYYY - example: 01/01/2016) 19) What Benefit Administration system are you currently using? 20) What Payroll and HR System(s) are you currently using? Payroll Frequencies (Check all that apply): 21) Weekly Yes No 22) Bi-Weekly Yes No 23) Semi-Monthly Yes No 24) Monthly Yes No 25) Other Yes No Company Structure and Benefit Classes: 26) Does the company offer varying benefits for different populations in the company? Yes No 27) If "Yes" on previous question, please explain: 28) Does the company offer varying waiting periods? Yes No 29) If "Yes" on previous question, please explain: 30) Does the company offer varying contribution levels? Yes No 31) If "Yes" on previous question, please explain: 32) Number of locations/divisions: 33) Will the company be importing current coverages? Yes No Unknown 34) Does the billing and/or system access need to be per location, division or department? Yes No Unknown 35) Does the client want to run a payroll file from the ben admin system to the payroll system? Yes No Unknown 36) If "Yes" on previous question, how many? 37) Do you want an incoming demographic file from your payroll system into the ben admin system? Yes No Unknown 38) If "Yes" on previous question, how many? OPTIONAL SERVICES: Single Sign On (SSO)*: 39) Will the client need the SSO Inbound? (i.e. from client HRIS or intranet to MarketLink) Yes No Unknown 40) Will the client need the SSO Outbound? (i.e. to carrier from MarketLink) Yes No ACA Tracking/Reporting Tool 41) Do you need ACA Tracking & Reporting tool? Yes No Total Compensation Statements*: 42) Do your need Total Compensation Statements? Yes No Spanish Capabilities*: 43) Are Spanish capabilities needed? Yes No Retiree Direct Bill*: 44) Do you need Retirees Direct Bill Yes No 45) Total number of Retirees: COBRA Administration 46) Does COBRA Administration needed? Yes No Spending Account Services 47) FSA (HCRA/DCRA) Yes No 48) HSA Yes No 49) HRA Yes No 50) Parking/Transit Yes No 51) Tuition Reimbursement Yes No Current Benefit Plans, by Type (Name of Carrier): 52) Medical (non-HSA) 53) Medical (HSA) 54) Dental 55) Vision 56) Group Life/AD&D 57) Group and/or Voluntary LTD 58) Group and/or Voluntary STD 59) FSA 60) Vol/Supp EE Life 61) Vol/Supp Spousal Life 62) Vol/Supp Dep Life 63) Worksite Products (i.e. AFLAC, Colonial, Allstate) 64) EAP 65) Cobra Legal & Privacy...