Client Eligibility Worksheet

AgriPlanNOW and BizPlanNOW Section 105 Health Reimbursement Arrangements (HRAs) save small business owners an average of more than $5,000 a year on their taxes. For those businesses with multiple employees, a cafeteria plan or Flexible Spending Arrangements (FSA, NESP/ NEFSA) may be better fit.

Please complete the form below – then click the Submit Button.

You will receive a Free Tax Savings Analysis

  • If you answered yes,

    Enter details in all that apply below.
  • Approximately how much do you spend annually on the following medical expenses?

    For Sole Proprietors or Single Entity Corporations, please include ALL household family medical expenses. For employers with multiple un-related employees, please include expenses for all employees participating in a group health plan(s) or who are being compensated for medical expenses by the employer
  • (include any accident, hospital indemnity, cancer, vision and dental insurance etc.)
  • (include prescription drugs, co-pays, deductibles, etc.)
  • (include contact lenses, glasses, eye exams, etc.)
  • (include routine cleanings, exams, etc.)
  • This field is for validation purposes and should be left unchanged.


Kevin Adams, Regional Sales Director