Client Details
   
* Client Name: 
* Address: 
Address 2:   
* City: 
* State: 
* ZIP Code: 
* Contact Full Name: 
* Contact Phone: 
* Contact Fax: 
* Contact Email: 
SAVE & CLOSE  
Division Details
       
* Division Name:  * Division Name: 
* Employer Tax I.D.:  * Employer Tax I.D.: 
* Address:  * Address: 
Address 2:    Address 2:   
* City:  * City: 
* State:  * State: 
* ZIP Code:  * ZIP Code: 
* Contact Full Name:  * Contact Full Name: 
* Contact Phone:  * Contact Phone: 
* Contact Fax:  * Contact Fax: 
* Contact Email:  * Contact Email: 
 
Division Details
   
* Division Name: 
* Employer Tax I.D.: 
* Address: 
Address 2:   
* City: 
* State: 
* ZIP Code: 
* Contact Full Name: 
* Contact Phone: 
* Contact Fax: 
* Contact Email: 
 

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COBRA/Direct Bill
Administration  >  Plan Renewals  >  Plan Details

Step 1 - Client Details  

Click on the icon below to view and edit your company demographic information.


                                           

Step 2 - Division

Select a division from the drop down box below to view or edit.

Or

Select "Add New" to create a new division.

Name:            

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