pir online form - Consova Corporation

Consova

Prospect Information Request

Please fill out and submit the Prospect Information Request Form below with as much information as you have available.

A Consova Sales Representative will produce a price quote and be in contact with you shortly.

Audit Participant

If you received a letter or email regarding a dependent eligibility audit and need assistance, please visit our help center.

Help Center

Let us help you take advantage of significant health plan savings

The Consova Difference:

Industry leader in Dependent Eligibility Verification (DEV)
Provides exceptional customer service throughout process
Highest level of employee participation w/active communication
Most comprehensive DEV program available today averaging better than a 10:1 ROI since 2003

Request Your Quote

PIR Online Form

First Name *

Last Name *

Phone *

Email *

If Applicable, Brokerage Name and Location

Organization Name Requesting Audit *

Organization Key Contact Name

Organization Location (City, State)

Please provide general information about your plan.

Last Time Your Organization Performed a Verification?

Is your Plan...

Self Funded

Fully Insured

Is Your Enrollment...

Active

Passive

What Percentage of Your Participants Enroll On-Line vs Paper Submission?

What is the Name of Your Benefits Administrator or the Name of Your In-House Benefit Administration System?

Are any Documents Collected When New Dependents are Added to the Plan Throughout the Year?

Yes

No

When is Your Medical Plan Renewal Date?

Please provide detail regarding the size of your plan and the nature of participants.

Total Number of Employees

Total Number of Employees Enrolled in the Medical Plan

Total Number of Employees That Cover at Least One Dependent (child or spouse) *

Total Number of Dependent Spouses

Total Number of Dependent Children

Average Annual Cost Per Dependent

Average Overall Medical Expense (all members)

Average Annual Turnover Rate (%)

Estimated Date the Audit will Begin

If a working spouse rule - such as a spouse surcharge or carve out/exclusion is in place - please provide the following information:

Describe the Working Spouse Rule in Place or Being Considered

Total Number of Spouses Enrolled in the Medical Plan(s)

Total Number of Spouses Participating in the Rule

Average Annual Cost per Spousal Dependent

If a Surcharge, What is the Monthly Rate Charged to the Employee

5 Million Dependents Reviewed

$1 Billion in Client Savings

98% Employee Response Rate

10:1 Return on Investment

Recent

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

Begin Your Journey Today!

866.529.9107

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