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Business Case (Individual)

Fill out the form below to submit your INDIVIDUAL/GROUP ASSOCIATION business case:

You can also fill out the Group Business Case Form.

Name*
First Last
Email*
Account Executive*
First Last
Business Case Date Submitted*
MM slash DD slash YYYY
Describe The Opportunity*
Summary description of the opportunity - including any other carriers, conversion opportunity, why Renaissance, risk, or reinsurance considerations
0 of 5000 max characters
Distribution Channel*
Who will be selling? - including the go to market strategy, current block, and relationship
0 of 5000 max characters
Commission Expectations*
Expected commission percentage
Number of Tiers*
Number of agent tiers
Number of Agents*
Number of agents currently working with the distributor
Current Enrollment: Dental*
Current enrollment in dental
Current Enrollment: Vision*
Current enrollment in vision
Group Association
Describe if associated specifically with this opportunity - including nature of association and relationship to agent/channel
0 of 5000 max characters
Number of Members
Number of members in the association
Membership Fees
Per Month
Marketing Fees To Association
Marketing Fees To Association (Percentage)
Percentage
Estimated Number Of New Subscribers: Dental*
Estimate number of new dental subscribers (minimum of 3 years)
Year 1 Year 2 Year 3
Estimated Number Of New Subscribers: Vision*
Estimate number of new vision subscribers (minimum of 3 years)
Year 1 Year 2 Year 3
Targeted Demographics*
List targeted customers (such as seniors, families, etc.)
Products To Be Offered*
What are the products to be offered? (If both group association and individual, select both)
Individual
Select individual products that will be offered
Individual Dental Products
Will the individual products be Renaissance or Delta?
Individual Available?
Are the dental and vision plans available? (You can write, Yes for one and No for the other, if needed)
Group Association
Select group association products that will be offered
Group Association Available?
Are the dental and vision plans available? (You can write, Yes for one and No for the other, if needed)
True Group
Select true group products that will be offered
True Group Available?
Are the dental and vision plans available? (You can write, Yes for one and No for the other, if needed)
Target Launch Date*
MM slash DD slash YYYY
How Will New Customers Enroll?*
(select all that apply)
Other Portal Description
If "Other Portal" was selected, describe the other portal that will be used
New Portal Eligibility
If "New Portal" was selected, describe if eligibility will be provided via 834 or another way
Who will administer billing?*
(select all that apply)
Who will issue certificates/policies?*
Who will provide ID cards?*
Risk Considerations*
Are there any risks to consider? - including reinsurance arrangements

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