Employers, please feel free to ask for a telephone contact, or you may request information via e-mail, see below.

All brokers, consultants and "others" will be contacted via telephone.

For StayFit Plan Info Contact: stayfitinfo@simplicityhealthplans.com

First, Please Tell Us About Yourself

Name		Required
Title		Required
Company		Required
City		Required
State		Required
E-mail Address		Required
Phone Number		Required
I am	An employer A broker A consultant Other, Please Describe	Required

To Have a Simplicity Representative Contact You at the Telephone Number Above,

If You Are an Employer and Want To Receive Additional Information Via E-Mail,

Please Fill in the Following Information

Number of Employees covered in your plan		Required
Are You Currently Self-insured?	Yes     No	Required
Plan Anniversary Month	January February March April May June July August September October November December
Do you currently have a Consumer Directed Health Plan?	Yes     No	Required
When would you be considering transitioning to a Consumer Directed Health Plan?	Next Anniversary 2 years from now Other	Required

Simplicity Health Plans
20600 Chagrin Blvd. Suite 450
Shaker Heights, Ohio 44122

tel: 877.747.1113
fax: 216.283.7931 
info@simplicityhealthplans.com