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Design On Line

Here's your opportunity to customize a health benefit plan for your company. What is your ideal benefit package? Go ahead, let yourself dream! You may be surprised how much benefit you can get for what you can afford to spend. Just answer the questions below and we'll reply with a preliminary design and cost estimate within 48 hours:


How much Freedom of Choice do you want?(Select ONE of the following)


	Any provider of your choice with no variation in benefits

	Any provider with higher benefits at "preferred providers"

	Network providers only

How will patient's access specialists? (Select ONE of the following)


	Direct access at patients discretion

	Access only with referral from "Primary Care Physician"

What Claim Costs, if any, will be your EMPLOYEES' responsability?


Office Visit Co-payment:$

Annual deductible in network:

Annual deductible out-of-network:

Co-insurance % in network:

Co-insurance % out-of-network:

Co-insurance maximum in network:

Co-insurance maximum out-of-network:

Would you like us to build any Consumer Directed features in your plan?


	Yes

	No

	Don't Know

Would you like your plan to include Health Reimbursement Accounts (HRAs) for your employees?


	Yes

	No

	Don't Know

If you wish to set up Health Reimbursement Accounts (HRAs):


Allocation per year to a single employee's HRA

Allocation per year to an employee's family HRA

Rx Drug Card


Generic drugs paid 100% after a co-pay of $

Brand drugs paid 100% after a co-pay of $

We're Almost Finished.


Number of Employees eligible for health benefits?

Number of employees covered by your current health plans

Name

Title

Company

Street Address

City, State

Zip Code

Phone Number

e-mail

What other features would you like your company's health plan to include?

"Last year, my Ford dealership was facing a 42% rate increase from our health insurance carrier ... Benemax showed us how to eliminate that increase and actually save money compared with our prior year ... and they did it without gutting our benefits and without changing carrier."

Michael Mullane, President

Mullane Ford

Bergenfield, NJ

Benemax
Seven West Mill Street
P.O.Box 950
Medfield, MA 02052
1-800-528-1530 X117
FAX: 508-359-3601

Benemax
14 Wall Street
20th Floor
New York, NY 10005
1-800-528-1530 X125

Benemax
3001 North Rocky Point Drive
Suite 211
Tampa, FL 33607
1-800-528-1530 X134

Dimensions Incorporated
813 Main Street
Avon-By-the-Sea, NJ 07717

Phone: (888) 775-7001