Implementation Plan

General case: It may take several days or more to gather all the information you need so plan ahead to have a comfortable implementation. If you hire us to construct your company database, know that it usually takes up to 10 business days to build and deploy a working solution, depending on the timing and quality of information you send us.

• Case Information

• Company name*
• Website URL
• Number of lives*

• Additional Information

• Additional information
  Do not include any protected health information.

• Case Implementation Contact Information

• Name*
  First Last
• Email*
• Phone*
• Extension

• Select Products

• Add one product per line. Click the plus button to add additional products.

  Pre-built, collaborating carrier products enroll for free. Check product availability.
  

  Benefit administration for $0 PEPM is available when select products are enrolled.
  Common Census can also build other benefits. Learn about custom builds

  Carrier name	Product name	Import coverage	Export type

• Carrier Rep Contact Information
  • Add carrier rep contact information

• Carrier name	Rep name	Email	Phone

• Additional Exports

• Payroll Export
  NoneExcelOther
• Payroll vendor name
• COBRA Export
  NoneExcelEDI
• COBRA vendor name
• ACA Export
  NoneExcelEDI
• ACA vendor name

Ready to submit

If you are ready to submit the case summary form, please go ahead an do so.

Submit later

If you would like more time, you may click the Save and continue later link below. This will provide you with a link where you can access the working form for up to 30 days. Once you submit the form, you must contact BenefitsUSA sales directly to make any changes to the case summary.

Email:
Phone: (207) 854-5454 x203