broker vaccine - Consova Corporation

Broker / Consultant

Employee Proof of Vaccination

Please complete the Employee Proof of Vaccination Free Estimate Form and a representative will schedule a call to review the solution.

Download our Overview Sheet

Broker Vaccine Request

Broker / Consulting Firm Name *

Contact Name *

Contact Phone *

Name of Client Organization *

Key Client Contact

Key Client Email

Key Client Contact Phone

Location of Client Headquarters *

What is the name of the benefits administrator or the name of the in-house benefit administration system?

Total Number of Employees *

Is the Vaccine Required for Employment?

Yes

No

Unknown

Total number of employees that have not already proven vaccination status *

Is the vaccine required to avoid a surcharge or incentive?

Yes

No

If Yes, How Much is the Surcharge or Incentive?

Are waivers for the vaccine being allowed?

Yes

No

Do they have email addresses for all employees?

Yes

No

Average annual turnover rate (%)

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Clients

Consova is dedicated to the goal of driving unnecessary costs out of healthcare. Working with household names such as Nokia, Sony, Sprint and many others, Consova has delivered over a billion dollars in healthcare savings to our clients.

Industries Include:

Automotive
Education
Financial
Healthcare
Hospitality

Insurance
Manufacturing
Retail
Technology
Transportation

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