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Application
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Add-ons
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Plan Selection
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Confirm

Applying for

Business / Group Benefits

Application Form

Fields marked with * are required.

Personal Information

Your SSN is encrypted and never shared.

Address

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Business Information

Tell us about your business so we can match you with the right group benefit plans.

🎖️

Veteran / Military Status

Veterans may qualify for additional life insurance discounts and special enrollment periods. This information is optional but helps us find the best rates for you.

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Medical History

Medical history helps us match you with the right life insurance carrier and tier. You may qualify for better rates with a clean history. This info is never shared without your consent.

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Income Verification (Optional)

HealthSherpa may request proof of income. Uploading now speeds up your enrollment. Acceptable documents: W-2, 1099, tax return, pay stub, or employer letter.

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Were You Referred by Someone?

If someone referred you but you don't have their link, tell us their name and state so they get credit!

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Quarterly Raffle — Win $500 + Custom Apparel!

Each quarter, one lucky community member wins $500 cash plus a t-shirt, sweater, or sweatpants of their choice with the VitalGrant.ai logo. Provide your sizes below — they'll be saved to your account so you're entered automatically.

Additional Notes