Skip to form
EmployeeBridge
Please tell us about you:
First Name
*
Last Name
*
Company
*
Job Title
*
Email
*
Business Phone
*
Mobile Phone
If you are an HR professional, business owner, or represent an employer, how many employees do you have?
*
Please Select
Less than 20
20 – 50
51 – 99
100 – 199
200+
How did you hear about EmployeeBridge?
*
Are you currently working with a broker?
*
Please Select
No
Yes, a broker for our group medical plan
Yes, a broker for individual health insurance
Preferred Method of Contact (please check all that apply)
*
Email
Call on business phone
Call on mobile phone
Text
I am interested in learning more about… (please check all that apply)
*
General information about EmployeeBridge
Incorporating EmployeeBridge into my HR strategy
Offering a Medicare 101 class to my company’s employees
Offering one-on-one Medicare consultations to Medicare-eligible employees
Offering a resource for COBRA consultations and COBRA alternatives
Offering consultations when a 26-year-old dependent ages off the group medical plan
Offering consultations when an employee reports they cannot afford the family tier in the employer plan
Optional Message
Submit