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Request NDA
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Non Disclosure Agreement
Please Fill Out the Form To Begin
Before we can clear a client to quote, we must get a signed NDA.
‍
1 - NDA Request Notification
When the Submit NDA Request button is pressed, the client or prospect will receive the NDA via email. This email will be sent from submissions@provision.health, so recipients should check their inbox and spam folders.

2 - Agreement Scope
All attendees of a call or presentation are subject to the terms of this NDA. It is the presenting broker’s responsibility to inform your client/prospect.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Request & Send NDA
Thank you! Your Request an NDA submission has been received!
Keep a look out in your email inbox with updates on the status of your submission, along with any additional questions a member from the ProVision Health submission team may have.

For questions, please feel free to reach out to submissions@provision.health
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Clearance Form
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need to clear the current prospect.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Client Information:
Min. of 200 Employees Req'd
Min. of 200 Employees Enrolled
1/6
Clearance Form
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need to clear the current prospect.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Client Information:
2/6
Clearance Form
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need to clear the current prospect.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Client Information:
Max file size 10MB.
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3/6
Clearance Form
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need to clear the current prospect.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Broker's Information:
4/6
Clearance Form
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need to clear the current prospect.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Broker Information (Submitter):
5/6
Clearance Form
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need to clear the current prospect.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Please submit your Clearance to Quote:
6/6
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Thank you! Your Clearance to Quote submission has been received!
Keep a look out in your email inbox with updates on the status of your submission, along with any additional questions a member from the ProVision Health submission team may have.

For questions, please feel free to reach out to submissions@provision.health

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ProVision Checklist
YOU MUST HAVE THESE REQUIREMENTS TO REQUEST A CLEARANCE TO QUOTE

Qualifications:

  • Is the headquarters in an Anthem state?
  • (States: CA, CO, CT, GA, IN, KY, MN, MO, NH, NV, NY, OH, VI, WI)
  • Are there min. of 200 employees enrolled?
  • *NOTE: Loss runs are only needed for groups over 250 enrollees.
  • Is the account currently with any Blue Cross entities?
  • There are no Blue Cross quoting irrespective of the broker.
  • The non-disclosure agreement has been digitally signed.
I have all these Items
ProVision Checklist
YOU MUST HAVE THESE REQUIREMENTS TO REQUEST A QUOTE

Submission requirements:

Full List Download Here

  • Must have ALL account background information.
  • 24 months min., 30 months ideal of claims history in excel format, if available.
  • RX separated from the core medical benefits
  • Facility claims separated from the Practitioner claims (If Possible).
  • Copy of all current plan designs in Summary of Benefits and/or SBC PDF formats ONLY.
  • Copy of recent monthly bill
  • Census on ProVision Census Template -Download Here
  • Effective date of current plans
  • Quote due date for presentation.
I have all these Items
Request To Quote
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need the required information.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Client Information:
1/9
Request To Quote
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need the required information.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Client Information:
Please provide any corporate structure and locations and tax ID#s
Max file size 10MB.
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2/9
Request To Quote
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need the required information.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Client Information:

Census data MUST be formatted using this template

Download Here
Max file size 10MB.
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3/9
Request To Quote
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need the required information.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Client Information:
Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.
Max file size 10MB.
Uploading...
fileuploaded.jpg
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4/9
Request To Quote
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need the required information.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Client Information:
Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.
5/9
Request To Quote
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need the required information.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Client Information:
Max file size 10MB.
Uploading...
fileuploaded.jpg
Upload failed. Max size for files is 10 MB.
6/9
Request To Quote
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need the required information.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Broker Information:
7/9
Request To Quote
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need the required information.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Broker Information (Submitter):
8/9
Request To Quote
Please Fill Out the Form To Begin
Before we can get a quote ready for you, we first need the required information.
***Form DOES NOT auto-save. Submissions MUST be completed fully.***
Please submit your Clearance to Quote:
9/9
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Thank you! Your Request to Quote submission has been received!
Keep a look out in your email inbox with updates on the status of your submission, along with any additional questions a member from the ProVision Health submission team may have.

For questions, please feel free to reach out to submissions@provision.health

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Oops! Something went wrong while submitting the form. Please try again.
Marketing & Sales Assets
Asset Requests

Broker Summit Recap Notes

ProVision Brokers Summit II_6-19-24
ProVision Brokers Summit III_01-15-25_Recap

PDFs

Pre_NDA_ProVision Health Narrative Deck
9-25_Proven Savings For Private Equity
Pre NDA ProVision One Pager

Emails Templates

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ProVision Savings Calculator

Calculator Link

Resources
Resource Requests

PDFs

EXAMPLE_Pre-NDA_ProVision-Promise
ProVision Health's Submission Checklist
Steps to Apply for Dunn & Bradstreet
ProVision Elevator Pitch
A Primer on Standard PPO Plans and Reference Based Price Plans

Spreadsheets

ProVision CENSUS TEMPLATE

Word Documents

POST-NDA_Performance Guaranty Agreement