Netcare Benefits Group
Company Name
# Full time Employees
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
25 and above
Contact Name
Phone #
email
Desired Plan
PPO Plan
POS Plan
HMO Plan
HSA Plan
Address
Current coverage
PPO
HMO
None
Dont Know
State
Desired Deductible
$500
$1000
$1500
$2500
$5000 or more
Zip code
Coverage Type
Health
Dental
Life
Disability
All of the above
Employee Name
Gender
DOB/ Age
Coverage Type
Medical Conditions
Male
Female
Employee only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Male
Female
Employee only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Male
Female
Employee only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Male
Female
Employee only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Male
Female
Employee only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Male
Female
Employee only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Male
Female
Employee only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Male
Female
Employee only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Male
Female
Employee only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Male
Female
Employee only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Male
Female
Employee only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Male
Female
Employee only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Male
Female
Employee only
Employee and Spouse
Employee and Child(ren)
Employee and Family
Male
Female
Employee only
Employee and Spouse
Employee and Child(ren)
Employee and Family
