REQUEST FOR PROPOSAL

Direct Pay Designs evaluates self-funded health plans through a structured underwriting and strategy process. To ensure accurate modeling, please complete the form below.

Before You Begin, be prepared to provide:

Employer census data

Current plan design

Stop-loss details

Claims experience (if available)

Renewal timeline

All information submitted is confidential.

First Name *

Last Name *

Email *

Phone *

Agency

State(s) Licensed In

License Number

Are you the current BOR?

Yes

No

If no, who is?

How did you hear about Direct Pay Designs?

Plan Sponsor

DBA (if applicable)

Address

Street Address

City

State

Country

Postal Code

SIC or NAICS Code

Industry Description

Situs State

Please upload any available documentation so we can begin review.

Census File *

Current Plan Documents *

Renewal Documents / Current Rates *

Stop Loss Claims Reports (24 months minimum)

Any additional Supporting Documents

Quote Timeline

Just exploring

Quote needed within 10 business days

Urgent / Large Group

Additional Notes?

I agree to terms & conditions provided by the company. By providing my email address and phone number, I agree to receive text messages and/or email communications from the business and understand I can opt out at any time. I confirm I have authorization to submit this information and understand that Direct Pay Designs will use it for proposal evaluation purposes.

Direct Pay Designs is a nationally licensed General Agency operating in all 50 states. Insurance products are offered through licensed entities. Non-insurance services are contracted separately to maintain transparency and compliance.

Links

Contact:

(888) 898-2507

[email protected]