Contact BeniComp IncentiCare
Contact BeniComp IncentiCare
Interested in a BeniComp IncentiCare plan? Please fill out the form below and we'll be in touch.
Are you an Advisor, Employer, or Referring Partner/Vendor?
*
Are you an Advisor, Employer, or Referring Partner/Vendor?
Advisor
Employer
Referring Partner/Vendor
Other
Other
Name
Name
*
First
Last
Company
*
Title
*
Email
*
Phone
Phone
*
-
###
-
###
####
Consent
Consent
By checking this box I consent to receive SMS Text messages from BeniComp using the number provided
Number of covered employees
*
Under 20
21-50
51-100
101-200
201-500
>500
Company Location
*
Alabama
Alaska
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
What is your company's current plan?
*
What is your company's current plan?
Fully-insured
Self-funded
Don't have an insurance plan
Other
Other
When does your health plan renew?
*
January
February
March
April
May
June
July
August
September
October
November
December
I don't know
How did you hear about BeniComp IncentiCare?
How did you hear about BeniComp IncentiCare?
In the news
Internet search
Email
Advisor (Insurance Agent)
Referral
Other
Other
Comments
Checkboxes
Checkboxes
First option
Second option
Third option