iPlanRx
We take the worry out of iCHRA™
Carrier Partner Intake
1
Company
2
ACA Plans
3
Networks
4
Formulary
5
Plan Docs
6
Counties
7
Payments
8
Service
9
Member Access
10
Unique Benefits
11
AI Partnership
Carrier Partner Intake

Insurance Carrier
Partnership Questionnaire

This questionnaire helps iPlanRx configure our AI-powered member benefits platform to accurately represent your plan offerings, provider networks, and formulary. All responses are confidential.

⚠
Confidential & Proprietary
This questionnaire and all associated questions are proprietary and confidential to iPlanRx. By completing and submitting this form, you acknowledge that its contents, methodology, and associated intellectual property may not be shared, reproduced, forwarded, or distributed without the express written consent of iPlanRx. Unauthorized use may constitute misappropriation of trade secrets.

1
Company Information
Primary Sales Contact — iPlanRx Partnership Lead
Form Completed By (if different from sales contact)
Select all states where your plans are currently active
2
ACA Plan Offerings
3
Provider Networks
Add one entry per network — the same carrier can have multiple networks
Important: Each provider network must be listed separately below. For each network, provide the name, type, states it covers, and the provider directory. This data drives how our AI routes provider lookup questions to the correct directory.
4
Formulary
Drug coverage — typically one formulary per carrier across all plans and networks
Note: We understand most carriers use a single formulary across all metal tiers and provider networks. If your organization uses more than one formulary (e.g., by state or plan type), please indicate that below and upload each one separately.
⚠ File Upload Limit: 10MB per file. If your documents exceed 10MB please email them directly to ichra.enrollment@iplanrx.com with your carrier name in the subject line.
PDF version of your current formulary — used to train the iPlanRx AI drug lookup tool
📄
Choose file or drag and drop
PDF only · Max 10MB · If your file exceeds 10MB email it to ichra.enrollment@iplanrx.com
5
Plan Documents — SBCs
Summary of Benefits and Coverage — one per plan
SBCs are the core training document for our AI benefits tool. Members and staff ask questions the SBC answers directly — deductibles, copays, covered services, out-of-pocket limits. The more SBCs you share, the more accurate our AI responses will be for your plan members.
⚠ File Upload Limit: 10MB per file. If your SBC files or ZIP exceed 10MB please email them to ichra.enrollment@iplanrx.com with your carrier name in the subject line. A ZIP file of all SBCs is preferred.
If you have all SBCs in one folder, zip them and upload here
🗂️
Choose ZIP or PDF or drag and drop
ZIP or PDF · Max 10MB · If your files exceed 10MB email them to ichra.enrollment@iplanrx.com
6
County & Network Availability
Which counties your plans are sold in, and which network applies
This is critical for iCHRA suitability analysis. When an employer has employees in multiple counties, we need to know which plans and networks are available in each county to verify iCHRA affordability and plan access.
Excel, CSV, or PDF listing counties with their available plans and networks
📊
Choose file or drag and drop
Excel / CSV / PDF · Max 10MB · If your file exceeds 10MB email it to ichra.enrollment@iplanrx.com
7
Payment & Billing
Premium payment setup, timing, and delinquency process
Select all dates of the month when premium can be drafted
Number of days after missed payment
8
Customer Service Contacts
Separate lines for member inquiries vs. broker inquiries
These numbers will be embedded in AI chat responses so members and staff always get routed to the right line — never stuck in the wrong queue.
The number a member calls for coverage, claims, or billing questions
The number brokers call — separate from the member line
9
Member Account Access
How members manage their coverage day-to-day
Can a member access a digital ID card through the app or portal?
Can a broker pull or view a member's ID card on behalf of the member?
10
Unique & Value-Added Benefits
Differentiators that make your plans stand out to members and employers
These details help our AI highlight your plan's unique value when members are comparing options. Wellness dollars, gift card incentives, and added perks are often the deciding factor for iCHRA members choosing a plan — make sure we know what you offer.
Dollar amounts, eligibility, how members access the benefit, any limitations
PDFs describing your unique offerings — used to enhance AI responses
📎
Choose files or drag and drop
Multiple PDFs · Max 10MB each · If files exceed 10MB email them to ichra.enrollment@iplanrx.com
9
AI Chat Partnership Interest
iPlanRx is building an AI-powered chat tool that helps iCHRA members and employers navigate their benefits. The data you provide will help us be a better partner in serving our clients and the states in which we operate.
1 = No interest  |  5 = High priority
Not a priority High priority

By submitting, you confirm you are authorized to share this information on behalf of your organization. All responses and uploaded documents are treated as confidential and used solely for iPlanRx platform configuration. A member of our team will follow up within 2 business days.

Questionnaire Received

Thank you, .

Your responses have been securely recorded by iPlanRx. A member of our team will be in touch within 2 business days to confirm your information and discuss next steps.

Our team will follow up to request any plan documents not included with your submission. If you have documents larger than 10MB — such as provider directories or SBC packages — please email them directly to ichra.enrollment@iplanrx.com with your carrier name in the subject line.

What Happens Next
1
iPlanRx reviews your responses and verifies your plan and network data within 2 business days.
2
Our team will reach out to collect your formulary, SBCs, and provider directory documents for AI knowledge base indexing.
3
AI benefits chat goes live — iPlanRx staff and your enrolled members can ask questions about your plans and receive accurate, sourced answers.
Confidentiality Reminder

Your responses are held in strict confidence by iPlanRx and used solely for platform configuration purposes. This questionnaire and its contents are proprietary to iPlanRx and may not be shared or reproduced.

Questions? Contact iPlanRx at info@iplanrx.com
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