Home
Solutions
About
Careers
Resources
- Blog
Contact

Home
Solutions
About
Careers
Resources
- Blog
Contact

Certifi

Pricing Information Form

Thanks for your interest in Certifi. To help us understand the needs and scope of your project so we can provide accurate pricing, please complete the information in the form below.

Step 1 of 4

25%

Company Information

Company Name(Required)

Main Contact Information

Name(Required)

First Last

Phone(Required)

Email(Required)

Population Breakdown

Who will Certifi be billing?(Required)

Individual

Group

Individual and Group

Will individuals also be part of the group bill?(Required)

Yes

No

Will participants be receiving multiple bills (e.g., one for Medicare and one for other products?)(Required)

Yes

No

Will Certifi be billing any subsidies?(Required)

Yes

No

Will Certifi need to bill the Sponsor for the portion of the subsidy to be paid (actual vs. notional)?(Required)

Actual

Notional

Estimated number of individual statements generated per month:(Required)

Estimated number of group statements generated per month:(Required)

Will Certifi need to integrate with a fulfillment vendor for statement and/or letter distribution?(Required)

Yes

No

Who is your fulfillment vendor?(Required)

Are broker commissions part of the service model?(Required)

Yes

No

How does the commissions process work today? Explain below:(Required)

Payment-Related Information

Are individuals/groups going to make payments online?(Required)

Yes

No

Will you accept ACH payments?(Required)

Yes

No

Will you accept credit cards (unlikely for group payments)?(Required)

Yes

No

Will you accept Retail Cash Pay (individual only)?(Required)

Yes

No

Do you anticipate charging fees to individuals based on payment method (e.g. more for check vs. ACH)?(Required)

Yes

No

Can individuals/groups make check payments?(Required)

Yes

No

Do you use lockbox processing?(Required)

Yes

No

Do you have more than one bank/lockbox?

Yes

No

Name of Bank(s) Used(Required)

Benefits Outsourcing

Names of other sources of funding, service providers, partners or vendors that may require Certifi to integrate (e.g., pension, HRA, HSA, VEBA, etc.) and service provided(Required)

Client Systems Information

Does your enrollment system have coverage that houses rates within it?(Required)

Yes

No

How will rates be communicated to Certifi?(Required)

Rates will be sent on coverage record

Rates file

Conversion/Transfer from Old Billing System(Required)

Clean Slate

Converted Balance

Unknown

What will be converted?(Required)

Single Balance

Payment and Billing History

Will Certifi support Parallel Conversion at go-live?(Required)

Yes

No

How long will Parallel Processing last? (recommend 3 months)(Required)

Operations

Select all Billing Cycles Supported(Required)

Monthly

Quarterly

Annual

Other

If you selected multiple billing cycles, will the same populations be billing (e.g., monthly and quarterly billed)

Yes

No

Will invoice and letter templates be customized by sponsor group? (Most likely applicable for Benefits Administrators)(Required)

Yes

No

Explain the customization.(Required)

Are there other factors that need to be considered for the project that are unique to your organization?(Required)

Name

This field is for validation purposes and should be left unchanged.

Certifi
5050 Lincoln Drive, Suite 450
Edina, MN 55436
info@certifi.com
(612) 235-6194

Certifi, Inc. All Rights Reserved © | Web Design by BlizzardPress | Privacy Policy | Accessibility

Start typing and press Enter to search

Skip to content

Accessibility Tools

Increase Text
Decrease Text
Grayscale
High Contrast
Negative Contrast
Light Background
Links Underline
Readable Font
Reset

Help
Feedback