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Step
1
of 6
Which markets do you serve?
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Group Benefits
Individual Insurance
Medicare
Select all that apply — this determines which questions you’ll see next.
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Your Name
*
First
Last
Email Address
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Phone Number
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Agency / Company Name
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Group products offered
Group Health
Group Dental
Group Vision
Group Long-Term Care
Group Disability
Why to URL
Group size range(s) handled
e.g. “2–50 employees”
Cost containment / savings strategies
FSAs, HSAs, HRAs, POPs
Partially-funded (level-funded) plans
Self-funded — Captive strategies
Self-funded — PBM management
Executive & retirement benefits offered
Key-person benefits (executive planning)
401(k) — offered directly
401(k) — offered via vendor partner
Group Medicare Supplement
Group Medicare Advantage
Voluntary benefits offered
Life
Accident
Disability
Long-Term Care
Dental & Vision
Critical Illness
Hospital Indemnity
Gap
Final Expense
Identity theft protection
Legal plan
Do you offer onsite consultations or visits?
Yes
No
Do you use benchmarking or claims analytics for plan design?
Yes
No
Group services offered
Corporate wellness services
Employee advocacy
Enrollment & plan integration
Admin & compliance (COBRA, ACA, ERISA)
Proactive annual renewal analysis
Online benefit portal
Compliance support via third-party vendors
Payroll
Featured Group Resources to include on your site
Benefits review / checkup page
Cost savings calculator
ACA Penalty Calculator
Benefits Benchmarking Tool
HR Compliance Calendar (Federal)
HR Compliance Calendar (State)
Open Enrollment Checklist
Which state(s) should the HR Compliance Calendar cover?
Individual Health products offered
Traditional (off-Marketplace)
Marketplace (ACA / on-exchange)
Short-term
Travel
Dental
Vision
Telemedicine
Supplemental Health products offered
Accident
Disability
Cancer
Critical Illness
Hospital Indemnity
Life Insurance products offered
Final Expense
Term Life
Permanent Life
Annuities
Featured Resources for Individual Clients to include
Life Insurance Needs Calculator — estimates recommended coverage from income, debts & dependents
Term vs. Whole Life Comparison Chart
Cost of Waiting Calculator — shows premium increase from delaying a life policy
“Which Health Plan Fits Me” Quiz
ACA Subsidy / Premium Tax Credit Estimator
Special Enrollment Period (SEP) Checker
Individual Insurance Glossary
Family Insurance Budget Worksheet
Open Enrollment Countdown / Reminder Sign-Up
These are plain-text tools for now — no example screenshots yet.
Are you currently using a quoting service for health quotes?
Yes
No
Carrier agent quote links
Paste any carrier-provided quoting links you have for individual health or Medicare.
Medicare products offered
Medicare Supplement
Medicare Advantage
Part D (prescription drug) plans
Featured Medicare Resources to include
About Medicare (explains Parts A, B, C, D)
Medicare national average costs (Parts A, B, D)
Medicare educational videos
Medicare option comparison chart (Original vs. Supplement vs. Advantage)
Medigap comparison chart
External links (SSA, Medicare.gov)
Fillable Medicare PDFs
Step-by-step enrollment guide + FAQ
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Which of these would you like included on your site?
Case Studies
Employee & Team Bios
Testimonials
Carrier Logos
Blog or News
If you select Case Studies or Employee & Team Bios, a section will open below to collect them.
Where should call-back form submissions go?
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Case Studies
Case Study Title / Industry
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e.g. “Regional Manufacturer — Group Health”. No company names.
Challenge & Result
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Short description of the problem and outcome.
Outcome Stat (optional)
e.g. “Reduced premiums 18%”
Add Another Case Study
Remove
Supporting Images or Files for Case Studies (optional)
Drag & Drop Files,
Choose Files to Upload
You can upload up to 5 files.
You can select multiple files at once.
Employee & Team Bios
Name
*
Email (optional)
Title
*
Phone (optional)
LinkedIn Profile URL (optional)
Short Bio
*
Keep it skimmable — aim for 3–4 sentences (~500 characters). You can set a hard character limit on this field in the builder after import.
Add Team Member
Remove
Employee Headshots (optional)
Drag & Drop Files,
Choose Files to Upload
You can upload up to 20 files.
Upload headshots for your team — you can select multiple files at once. File names don’t need to match the names above; we’ll follow up if we need help matching them.
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What's your philosophy toward clients?
Why are you different from, or better than, competitors?
What specific advantage would a client notice?
Company history / About Us
Certifications, designations, memberships, awards
Top carriers you'd like displayed (5–20)
One per line.
Would you like a blog or news section?
Yes
No
Anything else you'd like published on the site
Is standard insurance/Medicare disclaimer language okay to use?
*
Yes, standard language is fine
No, I need to review & customize
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Domain registrar
e.g. GoDaddy, Namecheap
Domain account username
We’ll follow up separately for your password through a secure channel — please don’t enter it here.
Would you like a “coming soon” page up in the meantime?
Yes
No
Referring URL
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