Employer Network Application

Name *

Role/Title *

Email *

Company Name *

Company Size *

Does your company offer health insurance to employees? *

Yes No

Does your health plan have members in Dallas-Fort Worth? *

Yes No Unsure

What locations/cities where you have employees? *

Please list all locations where your employees are based.

What type of health insurance plan do you offer? *

Do you use an independent TPA to administer your plan? *

Yes No Other/Unsure

What provider network or insurance company does your plan currently use? *

Do you currently have an arrangement with your carrier or TPA that allows you to enter into direct contracts with healthcare providers? *

Yes No Unsure

Share any other information we should know about your health plan or aspirations

There are currently two ways to work with Cost Plus Wellness contracts:

1. Cost Plus Wellness Turnkey - Employers must work with one of our approved TPAs to implement the contracts.
2. Cost Plus Wellness DIY - Use any TPA and any Cost Plus Wellness contract, but implementation is your responsibility working directly with each provider.

You can learn more about these options here.

Which option are you interested in? *

Cost Plus Wellness Turnkey Cost Plus Wellness DIY Unsure

Employer Health Plan Inquiry