BeniFIT Quote Document Upload

Below is a list of all of the documents needed for an BeniFIT Quote. If some of the documents are combined into one PDF then please include notes in the bottom of the form.

Click here to upload multiple documents:
Multiple Document Upload

Employer Name
Requesting Broker Requesting Broker First Last
Broker Email
Is your client Self-Funded or Fully Insured?

Is your client Self-Funded or Fully Insured? Self-Funded Fully Insured
Summary of Benefits and Coverage (SBC)

Attach Files
Census on the health plan (names, age, coverage assignment minimum)

Attach Files
Current premium and renewal rates (current year and renewal year)

Attach Files
Minimum Attachment Point
Expected Claims
TPA Name
TPA Fees
Broker Fees
Current network (fees included)
Current UM/DM/CM fees
COBRA rates

Attach Files
Additional document uploads

Please include descriptive document names before uploading. You can upload multiple files at once.
Additional Documents 1

Attach Files
Additional Documents 2

Attach Files
Additional Notes

BeniFIT Quote Document Upload

BeniFIT Quote Document Upload

Additional document uploads