Employer Information
Company Information
Company Name
* Please Enter Company Name.
Zip Code
ZIP Code should be 5 digits.
Total Number Of Employees
* Please Enter Number Of Employee.
Agent ID
* Please Enter Agent Id.
Effective Date
Please Select Effective Date.
Contact Information
First Name
* Please Enter First Name.
Last Name
* Please Enter Last Name.
* Please Enter Email. Please Enter Correct Email.
* Please Enter Phone Number. Phone number should be 10 digits.
Product Selection
Please select the products you wish to offer to your employees.
Payment Information
After your employees enroll, you will be sent an invoice with a complete employee census. You will not be charged until you have approved the invoice.
Select Payment Method
First Name
* Please Enter Billing First Name.
Last Name
* Please Enter Billing Last Name.
* Please Enter Billing Address.
* Please Enter Billing City.
* Please Enter Billing State.
Zip Code
* Please Enter Billing ZIP Code. ZIP Code should be 5 digits.
Accepted Payment Method Visa, MasterCard, American Express, Discover
Credit Card Number
(no spaces or hyphens please)
Please Enter Card Number.
* (What's this?)
Please Enter CVC Code.
Expiration Date
* Please Select Expiry Month.
* Please Select Expiry Year.
Please send payment by check to:
Transparent Health Group
630 Fairview Rd, Suite 207
Swarthmore, PA 19081
Thank you for enrolling with THC. We will email you a confirmation with online enrollment instructions shortly, including your THC Employer ID number. If you need assistance or have any questions, please call THC Group Sales at 888-770-7450 or email Employer@TransparentHealthGroup.com