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      • Base Health
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      • 401K Retirement Plan
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    • Proposal Request
    • Employee Enrollment
    • Payment Authorization
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Request a Quote
or Call 888-920-7526

Step 1 of 4

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  • Name of company, DBA or sole proprietorship.
  • Please enter business EIN, Tax ID or sole proprietor social security number.
  • Is the primary contact also the billing contact?
  • If you are new to Planstin please select, "New Company Setup". If you are making a plan change, please select, "Company Change".
  • Enter your existing group number.
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  • Select the services that you would like to enroll in with Planstin.
  • Please enter a number greater than or equal to 1.
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  • By choosing to self-fund or level-fund your company medical plan you’re creating an employer sponsored plan under the Employment Retirement Income Security Act (“ERISA”) and the Patient Protection and Affordable Care Act (“PPACA”). Reoccurring monthly payments by credit card or bank account draft are required. Planstin may cancel or charge additional administrative fees if not on a reoccurring payment plan.
  • The Preventive plan series are level-funded plans. By electing to level-fund your claims with us you are locking in your rate for the plan year and forfeit any unearned claim funds.
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  • Our preferred method of payment is using your business checking account and there is no fee for this option. If you choose to pay using credit card, there is an additional 3% processing fee. If you choose to be invoiced there is an additional $25 fee.
  • How would you like to pay for the setup fee?
  • Visa, Mastercard & Discover
  • What name is the account in? (Ex: "ABC Sample Business" or name of sole proprietor)
  • By typing your name below you are giving payment authorization for initial and monthly payment of enrolled plans. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Planstin Inc in writing of any changes in my account information within 15 days. This payment authorization is required for plan administration. In the case of an ACH or Credit Card Transaction being rejected for Non-Sufficient Funds (NSF) I understand that Planstin Inc or its assigned third party may at its discretion attempt to process the charge again within 30 days, and agree to an additional $25 charge for each attempt returned. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I agree not to dispute this recurring billing so long as the transactions correspond to the terms indicated in this authorization form.
  • Enrollment of employees are to be completed after the company setup. Once completed you will receive additional instructions for each employee to enroll in benefits.
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Claim Information

Payer ID:
65241

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CLAIM ADDRESS:

Planstin Administration
P.O. Box 21747
Eagan, MN 55121



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Contact Us

Phone: 888-920-7526
Email: member@planstin.com

Planstin Administration Inc @ 2018