iPlanRx
We take the worry out of iCHRA™
iCHRA Platform Partner Intake
1
Company
2
Platform
3
AOR & Enrollment
4
Payments
5
Compliance
6
Integrations
7
Pricing
8
Member Exp.
9
AI Partnership
iCHRA Platform Partner Intake

iCHRA Platform
Partnership Questionnaire

This questionnaire helps iPlanRx understand your platform's capabilities, integration options, and advisor of record structure. All responses are confidential and used solely for iPlanRx platform configuration.

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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 you have active employer clients
2
Platform Core Capabilities
3
Agent of Record & Enrollment
AOR designation and enrollment submission structure
Important: iPlanRx needs to understand AOR structure before recommending your platform to employer clients. These questions determine how we can legally represent clients on your platform in each state.
Agent of Record
Enrollment Submissions
4
Payment & Reimbursement
How HRA funds flow from employer to member
5
Compliance & Reporting
6
Technology & Integrations
7
Pricing & Advisor Economics
PEPM fees, minimums, and advisor compensation structure
Can iPlanRx add an advisory service fee on top of the platform PEPM?
8
Member Experience & Communication
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 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. A member of the iPlanRx team will follow up within 2 business days.

If you have documents to share, please email them to ichra.enrollment@iplanrx.com with your platform name in the subject line.

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
111 N. Broadway Suite C, Green Bay, WI  |  525 Junction Rd Suite 6500, Madison, WI