ICHRA Strategy

Session Interest Form

Company name *

Contact first name *

Contact last name *

Contact Role/Position (Owner / HR / Finance / Broker / Other) *

Phone number (best number to reach you) *

Email address *

Employee count *

States where employees work (select all that apply) *

When would you like to start offering the benefit? *

Do you offer group health today? *

Primary reason for reaching out (Costs / Remote team / First-time offering / Admin / Other) *

I agree that by providing my phone number and email address to Gwinnett Medicare LLC, I may receive SMS messages and emails from Gwinnett Medicare LLC and/or Gwinnett Medicare LLC brokers and other staff.