Principal Kickoff

This intake form will help us produce your Enrollment Meeting on Demand™ and build your company Hub.

Please have the following information ready:

Client, Broker, and Contact Details
Copies of all benefit summaries and SBCs or compliance documents in place.
You can leave this form at any time—your progress will be saved automatically.
Broker and client logo.

Principal Contact

Name*

Email*

Phone*

Offered Lines of Coverage*

Enrollment matters, please notate which lines are "New" this plan year and Sherp™ will make sure to point this out to employees at open enrollment to make sure they understand the details!

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Marked Lines of Coverage

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Employer Paid New Lines of Coverage

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Voluntary New Lines of Coverage

Broker Agency Detail

Broker Agency Name*

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Broker Web Address*

Broker Name*

Broker Email*

Broker Office Phone

If you would like to receive SMS updates about this group's progress, please enter your mobile number below.

Broker Mobile

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Broker Admin Support Contact Name*

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Broker Support Phone*

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Broker Admin Support Contact Email*

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Broker Address*

Street Address City State / Province / Region ZIP / Postal Code Country

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What enrollment platform is this group using?*

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Broker logo

Drop files here or

Accepted file types: jpg, png, jpeg, webp, Max. file size: 100 MB.

Client Info

Company Name*

Benefit Renewal Month*

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Company Website Link*

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Company Address

Street Address City State / Province / Region ZIP / Postal Code Country

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Company Logo

Drop files here or

Accepted file types: jpg, png, jpeg, webp, Max. file size: 100 MB.

Does this group has spanish speaking needs

HR Contact Info

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HR Contact

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HR Email

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HR Phone

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HR Calendar Link

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When Sherp™ engages with employees, we share a summary of their need along with basic contact information. Please select who should receive these communications:

HR & Broker

HR Only

Broker Only

Eligibility & Structure

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Benefit Plan Eligibility

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Waiting Period for Full Time

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Waiting Period for Part Time

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Is coverage available to spouses or dependents?

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Is this group subject to COBRA?

This group is subject to COBRA. Please ensure that continuation coverage rights are provided to qualified beneficiaries as required under federal law.

Benefit Plan Detail

Please upload all the benefit summaries you wish to have reviewed in your Enrollment Meeting on Demand™.

Please upload only one document per plan type, and note that benefit summaries are preferred over medical SBC's. The compliance upload below is where SBC's should be uploaded. If medical benefit summaries are not available, you can upload the SBC's here ( not preferred ).

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Click to upload files here

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB.

Healthcare Cost Sharing Programs in Place (HRA/HSA/FSA/DCA/Parking & Transit)

Please indicate which cost sharing benefit programs are currently active and funded by your employer group. This information helps us tailor communication templates that reflect the programs available to your employees. You’ll have the opportunity to review and edit each message before it’s shared on your proofing form.

Compliance and Company Document Upload

Please upload any SBC's and additional non-benefit related documents that you would like housed on your Benefit Hub and made available to employees. Include any compliance, plan documents, current benefits guide and company policy documents here.

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Click to upload files, or drag & drop files here

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB.

Important Contacts:

Please upload all contact information that should be provided to employees during the Enrollment Meeting on Demand. This includes carrier contacts, web URLs, email addresses, phone numbers, and any other contacts that employees may need to utilize.

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Contact Sheet

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Contact Sheet Values

Contact

Name

Phone

Website

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Can you please provide your health carrier's network provider search link?

Poster Style

Now that we have your benefit plan details, it's time to select your poster style to direct employees to their benefit hub at open enrollment and year round. If you have Spanish-speaking employees, copies will be provided in both English and Spanish.

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Poster Style

Get Additional Posters

We provide 5 sets of posters in some cases you may want a few more! They go by exits, in common areas, lunch rooms, by time clocks (in front of employees eyes 😉). **Remember they come in two flavors! Open Enrollment and Ongoing Support **. If you would like additional posters you can easily purchase here and shipped direct.

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Yes, I need a few more sets!

YES! I need a few more sets!

Total Sets English

Price: $7.00

Total Sets Spanish

Price: $7.00

Total

Credit Card*

Card Details

Cardholder Name

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Ship to*

Broker

Group

Other

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Shipping Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Terms & Conditions:

By submitting this intake form, you confirm that the benefit summaries, plan documents, and relevant client information provided are accurate, complete, and current. This information will be used to generate the script and build your custom Enrollment Meeting on Demand™ (EMOD™) experience.

Submission & Script Generation

The script is generated based entirely on the benefit materials and supporting documents you upload. These documents—along with any eligibility rules and compliance notices—shape the messaging delivered to employees.

Proofing & Review Process

Once the script is generated, you will receive a separate proofing form to review the content before production. You will have 96 hours to submit any edits. A reminder will be sent at the 72-hour mark with the option to request more time. If no edits are submitted within the 96-hour window, the script will be considered approved and will move forward to production. Post-deadline edits may require reprocessing and a $295 fee.

Responsibility & Review

All content is based on the materials you provide. O’Eme does not independently verify plan details, compliance documents, or eligibility rules. It is the responsibility of the submitting broker or group representative to ensure the completeness and accuracy of all information uploaded.

A2P SMS Permission

O’Eme’s SMS automations are optional. When providing employee contact information, you authorize O’Eme to send limited A2P SMS messages to support open enrollment and benefits communication. All messages include opt-out instructions. You confirm that your employees have granted permission for company-based communications through their employment agreement.

By finalizing this intake form—with accurate representation of the plans in force, eligibility criteria, and any applicable compliance materials—you’re helping us deliver a fully produced, custom-branded communication asset in just days. What normally takes weeks through traditional vendors is now fast, easy, and aligned to your client's brand.

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Acknowledgment & Acceptance*

I acknowledge and accept the terms above, including responsibility for the accuracy of materials submitted and awareness of the downstream review and production process.

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Submitted by:*

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Parent entry id

If this form is refilled by broker then this is the id of entry from which it is getting filled.

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Child entry id

If this form has been used for filling the a new form by broker then this contains the entry id of that form.

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Unique ID

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Benefit Hub QR Code

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Carrier Company Name

CAPTCHA

Phone

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

Kickoff Form

Principal Contact

Broker Agency Detail

Client Info

HR Contact Info

Eligibility & Structure

Benefit Plan Detail

Healthcare Cost Sharing Programs in Place (HRA/HSA/FSA/DCA/Parking & Transit)

Compliance and Company Document Upload

Important Contacts:

Poster Style

Get Additional Posters

Terms & Conditions: