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solid var(--leaf-base-color-action-blue-100);--leaf-border-button-tertiary-hover:2px solid var(--leaf-base-color-action-blue-100);--leaf-color-border-active-outline:var(--leaf-base-color-neutral-100);--leaf-color-border-info:var(--leaf-base-color-navy-100);--leaf-color-border-warning:var(--leaf-base-color-yellow-100);--leaf-color-border-error:var(--leaf-base-color-red-100);--leaf-color-border-success:var(--leaf-base-color-green-100);--leaf-color-border-brand-strong:var(--leaf-base-color-navy-100);--leaf-color-border-brand-subtle:var(--leaf-base-color-action-blue-20);--leaf-color-border-brand:var(--leaf-base-color-action-blue-100);--leaf-color-border-disabled:var(--leaf-base-color-neutral-50);--leaf-color-border-knockout:var(--leaf-base-color-neutral-white);--leaf-color-border-strong:var(--leaf-base-color-neutral-80);--leaf-color-border-default:var(--leaf-base-color-neutral-20);--leaf-color-content-success:var(--leaf-base-color-green-120);--leaf-color-content-link-disabled:var(--leaf-base-color-neutral-60);--leaf-color-content-link-visited:var(--leaf-base-color-purple-100);--leaf-color-content-link-active:var(--leaf-base-color-action-blue-160);--leaf-color-content-link-hover:var(--leaf-base-color-navy-100);--leaf-color-content-link:var(--leaf-base-color-action-blue-100);--leaf-color-content-info-icon:var(--leaf-base-color-navy-100);--leaf-color-content-warning-icon:var(--leaf-base-color-neutral-100);--leaf-color-content-error-icon:var(--leaf-base-color-red-100);--leaf-color-content-error:var(--leaf-base-color-red-100);--leaf-color-content-success-icon:var(--leaf-base-color-green-100);--leaf-color-content-brand-strong:var(--leaf-base-color-navy-100);--leaf-color-content-brand:var(--leaf-base-color-action-blue-100);--leaf-color-content-brand-knockout:var(--leaf-base-color-action-blue-20);--leaf-color-content-knockout:var(--leaf-base-color-neutral-white);--leaf-color-content-disabled:var(--leaf-base-color-neutral-60);--leaf-color-content-subtle:var(--leaf-base-color-neutral-80);--leaf-color-content-default:var(--leaf-base-color-neutral-100);--leaf-color-bg-strong:var(--leaf-base-color-neutral-100);--leaf-color-bg-active:var(--leaf-base-color-neutral-100);--leaf-color-bg-brand-xstrong-active:var(--leaf-base-color-navy-160);--leaf-color-bg-brand-xstrong-hover:var(--leaf-base-color-navy-140);--leaf-color-bg-brand-xstrong:var(--leaf-base-color-navy-100);--leaf-color-bg-brand-hover:var(--leaf-base-color-action-blue-10);--leaf-color-bg-default-hover:var(--leaf-base-color-action-blue-10);--leaf-color-bg-brand-strong-active:var(--leaf-base-color-action-blue-160);--leaf-color-bg-brand-strong-hover:var(--leaf-base-color-action-blue-140);--leaf-color-bg-brand-strong:var(--leaf-base-color-action-blue-100);--leaf-color-bg-brand:var(--leaf-base-color-action-blue-20);--leaf-color-bg-info-strong:var(--leaf-base-color-navy-100);--leaf-color-bg-info:var(--leaf-base-color-action-blue-20);--leaf-color-bg-warning-strong:var(--leaf-base-color-yellow-100);--leaf-color-bg-warning:var(--leaf-base-color-yellow-20);--leaf-color-bg-error-strong:var(--leaf-base-color-red-100);--leaf-color-bg-error:var(--leaf-base-color-red-20);--leaf-color-bg-success-strong:var(--leaf-base-color-green-100);--leaf-color-bg-success:var(--leaf-base-color-green-20);--leaf-color-bg-disabled:var(--leaf-base-color-neutral-10);--leaf-color-bg-knockout:var(--leaf-base-color-neutral-100);--leaf-color-bg-subtle:var(--leaf-base-color-neutral-05);--leaf-color-bg-default:var(--leaf-base-color-neutral-white);--leaf-button-padding-horizontal-icon-only:var(--leaf-base-spacing-4);--leaf-button-padding-horizontal-medium:var(--leaf-base-spacing-24);--leaf-button-padding-horizontal-small:var(--leaf-base-spacing-16);--leaf-button-padding-horizontal-large:var(--leaf-base-spacing-32);--leaf-button-padding-vertical-icon-only:var(--leaf-base-spacing-4);--leaf-button-padding-vertical-medium:var(--leaf-base-spacing-12);--leaf-button-padding-vertical-large:var(--leaf-base-spacing-16);--leaf-button-padding-vertical-small:var(--leaf-base-spacing-8);--leaf-color-button-tertiary-outline:var(--leaf-base-color-neutral-100);--leaf-color-button-tertiary-content-disabled:var(--leaf-base-color-neutral-50);--leaf-color-button-tertiary-content-active:var(--leaf-base-color-action-blue-100);--leaf-color-button-tertiary-content-hover:var(--leaf-base-color-action-blue-100);--leaf-color-button-tertiary-content:var(--leaf-base-color-action-blue-100);--leaf-color-button-tertiary-border-active:var(--leaf-base-color-action-blue-100);--leaf-color-button-tertiary-border-hover:var(--leaf-base-color-action-blue-100);--leaf-color-button-tertiary-bg-active:var(--leaf-base-color-action-blue-20);--leaf-color-button-secondary-outline:var(--leaf-base-color-neutral-100);--leaf-color-button-secondary-content-active:var(--leaf-base-color-action-blue-100);--leaf-color-button-secondary-content-hover:var(--leaf-base-color-action-blue-100);--leaf-color-button-secondary-content:var(--leaf-base-color-action-blue-100);--leaf-color-button-secondary-content-disabled:var(--leaf-base-color-action-blue-50);--leaf-color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variant="full-width" columns="3"> <div slot="link-label"> Who We Serve </div> <h3 slot="sub-menu-heading">Who We Serve</h3> <div slot="content"> <ul> <li><h3 class="leaf-u-typography-label-large">By Size</h3></li> <li><a href="/employers/small-business" target="_self">Small Businesses (2-99 employees)</a></li> <li><a href="/employers/small-to-midsize-business" target="_self">Small to Midsize Businesses (100-499 employees)</a></li> <li><a href="/employers/midsize-to-large-business" target="_self">Midsize to Large Businesses (500-2,999 employees)</a></li> <li><a href="/employers/large-business" target="_self">Large Businesses (3,000+ employees)</a></li> </ul> <ul> <li><h3 class="leaf-u-typography-label-large">By Type</h3></li> <li><a href="/employers/business-types#hospitals-health-systems" target="_self">Hospitals and Health Systems</a></li> <li><a href="/employers/business-types#higher-education" target="_self">Higher Education</a></li> <li><a href="/employers/business-types#k-12" target="_self">K-12 Education</a></li> <li><a href="/employers/business-types#state-local-governments" target="_self">State and Local Governments</a></li> <li><a href="/employers/business-types#taft-hartley" target="_self">Taft-Hartley and Federal</a></li> <li><a href="/employers/business-types/third-party-administrators" target="_self">Third-Party Administrators</a></li> <li><a href="/employers/business-types" target="_self" class="leaf-u-link--action leaf-u-link--no-underline">View all business types</a></li> </ul> <ul> <li><h3 class="leaf-u-typography-label-large">International</h3></li> <li><a href="https://www.cignaglobal.com/" target="_blank">Health Insurance for Expats</a></li> <li><a href="https://www.cignahealthbenefits.com/en" target="_blank">IGO/NGOs</a></li> <li><a href="https://www.cignaglobalhealth.com/" target="_blank">Multinational Businesses</a></li> </ul> </div> </chc-header-dropdown> </li> <li slot="secondary-nav-left-links" match-path="/employers/why-cigna/"><a href="/employers/why-cigna/" target="_self" aria-label="Why Cigna Healthcare" aria-expanded="false">Why Cigna Healthcare</a></li> <li slot="secondary-nav-left-links" match-path="/employers/insights/"> <chc-header-dropdown variant="full-width" columns="2"> <div slot="link-label"> Employer Resources </div> <h3 slot="sub-menu-heading">Employer Resources</h3> <div slot="content"> <ul> <li><a href="/employers/cigna-for-employers/" target="_self">Cigna for Employers Portal Features</a></li> <li>Learn more about the tools and resources you'll have access to in the Cigna for Employers online portal.</li> </ul> <ul> <li><h5 class="leaf-u-typography-label-large">Industry Insights</h5></li> <li><a href="/employers/insights/informed-on-reform/" target="_self">Informed on Reform</a></li> <li><a href="/employers/insights/topic-workplace-wellness" target="_self">Workplace Wellness</a></li> <li><a href="/employers/insights/topic-cdhp" target="_self">Consumer-Driven Health Plans</a></li> <li><a href="/employers/insights/" target="_self" class="leaf-u-link--action leaf-u-link--no-underline">View all Industry Insights</a></li> </ul> </div> </chc-header-dropdown> </li> <li slot="login-button"> <leaf-button inverted="true" variant="primary" href="https://cignaforemployers.cigna.com/public/app/signin" target="_blank"> Log in to Employer Portal </leaf-button> </li> <li slot="login-button-mobile"> <leaf-button inverted="true" variant="primary" size="sm" href="https://cignaforemployers.cigna.com/public/app/signin" target="_blank"> Log in to Employer Portal </leaf-button> </li> <li slot="mobile-secondary-nav-links"> <leaf-accordion> <leaf-accordion-panel-inline> <h4 slot="showHeader">Plans and Services</h4> <h4 slot="hideHeader">Plans and Services</h4> <ul> <li><a href="/employers/medical-plans/" target="_self">Medical</a></li> <li><a href="/employers/pharmacy/" target="_self">Pharmacy</a></li> <li><a href="/employers/health-wellness-programs/" target="_self">Health and Wellness Programs</a></li> <li><a href="/employers/behavioral-health/" target="_self">Behavioral Health Programs</a></li> <li><a href="/employers/dental-and-vision/" target="_self">Dental and Vision</a></li> <li><a href="/employers/savings-spending-accounts/" target="_self">Health Savings and Spending Accounts</a></li> <li><a href="/employers/cost-control/" target="_self">Cost Control Strategies</a></li> <li><a href="/employers/additional-insurance/" target="_self">Supplemental Health Solutions</a></li> </ul> </leaf-accordion-panel-inline> </leaf-accordion> </li> <li slot="mobile-secondary-nav-links" match-path="/employers/who-we-serve/"> <leaf-accordion> <leaf-accordion-panel-inline> <h4 slot="showHeader">Who We Serve</h4> <h4 slot="hideHeader">Who We Serve</h4> <ul> <li><a href="/employers/small-business" target="_self">Small Businesses (2-99 employees)</a></li> <li><a href="/employers/small-to-midsize-business" target="_self">Small to Midsize Businesses (100-499 employees)</a></li> <li><a href="/employers/midsize-to-large-business" target="_self">Midsize to Large Businesses (500-2,999 employees)</a></li> <li><a href="/employers/large-business" target="_self">Large Businesses (3,000+ employees)</a></li> <li><a href="/employers/business-types#hospitals-health-systems" target="_self">Hospitals and Health Systems</a></li> <li><a href="/employers/business-types#higher-education" target="_self">Higher Education</a></li> <li><a href="/employers/business-types#k-12" target="_self">K-12 Education</a></li> <li><a href="/employers/business-types#state-local-governments" target="_self">State and Local Governments</a></li> <li><a href="/employers/business-types#taft-hartley" target="_self">Taft-Hartley and Federal</a></li> <li><a href="/employers/business-types/third-party-administrators" target="_self">Third-Party Administrators</a></li> <li><a href="/employers/business-types" target="_self">View all business types</a></li> <li><a href="https://www.cignaglobal.com/" target="_blank">Health Insurance for Expats</a></li> <li><a href="https://www.cignahealthbenefits.com/en/" target="_blank">IGO/NGOs</a></li> <li><a href="https://www.cignaglobalhealth.com/" target="_blank">Multinational Businesses</a></li> </ul> </leaf-accordion-panel-inline> </leaf-accordion> </li> <li slot="mobile-secondary-nav-links" match-path="/employers/why-cigna/"><a href="/employers/why-cigna/" target="_self">Why Cigna Healthcare</a></li> <li slot="mobile-secondary-nav-links" match-path="/employers/insights/"> <leaf-accordion> <leaf-accordion-panel-inline> <h4 slot="showHeader">Employer Resources</h4> <h4 slot="hideHeader">Employer Resources</h4> <ul> <li><a href="/employers/cigna-for-employers/" target="_self">Cigna for Employers Portal Features</a></li> <li><a href="/employers/insights/informed-on-reform/" target="_self">Informed on Reform</a></li> <li><a href="/employers/insights/topic-workplace-wellness" target="_self">Workplace Wellness</a></li> <li><a href="/employers/insights/topic-cdhp" target="_self">Consumer-Driven Health Plans</a></li> <li><a href="/employers/insights/" target="_self">View all Industry Insights</a></li> </ul> </leaf-accordion-panel-inline> </leaf-accordion> </li> </chc-header> </div> </div> </div> </div> </div> <div class="iw_section" id="sectionlmxi0evd"> <div class="row iw_row iw_stretch" id="rowlmxi0eve"> <div class="columns iw_columns large-12" id="collmxi0evf"> <div class="iw_component" id="iw_comp1698403835981"> <style>#iw_comp1698403835981{}</style><leaf-breadcrumbs> <leaf-breadcrumbs-item href="/">Home</leaf-breadcrumbs-item> <leaf-breadcrumbs-item href="/employers/">Employers</leaf-breadcrumbs-item> <leaf-breadcrumbs-item href="/employers/business-types/" mobile-breadcrumb="true">Business Types</leaf-breadcrumbs-item> <leaf-breadcrumbs-item>Customized Solutions for Third Party Administrators</leaf-breadcrumbs-item> </leaf-breadcrumbs> </div> </div> </div> </div> <div class="iw_section" id="sectionl2h63b1e"> <div class="row iw_row iw_stretch" id="rowl2h63b1f"> <div class="columns iw_columns large-12" id="coll2h63b1g"> <div class="iw_placeholder" id="iw_placeholder1651039167649"></div> </div> </div> </div> <div class="iw_section" id="sectionlmxi0evh"> <div class="row iw_row iw_stretch" id="rowlmxi0evi"> <div class="columns iw_columns large-fullwidth" id="collmxi0evj"> <div class="iw_component" id="iw_comp1698403835982"> <style>#iw_comp1698403835982{}</style><chc-hero variant="tertiary" background="navy" pattern="leaf-circle"> <h1 slot="heading">Payer Solutions for Third-Party Administrators</h1> <div slot="content"> <p>Delivering value for Third-Party Administrators.</p> </div><picture slot="image"></picture><leaf-flex-container slot="cta"></leaf-flex-container> </chc-hero> </div> </div> </div> </div> <div class="iw_section" id="sectionlp5p9nlv"> <div class="row iw_row iw_stretch" id="rowlp5p9nlw"> <div class="columns iw_columns large-12" id="collp5p9nlx"> <div class="iw_placeholder" id="iw_placeholder1700411776194"></div> </div> </div> </div> <div class="iw_section" id="sectionl0697wia"> <div class="row iw_row iw_stretch" id="rowl0697wib"> <div class="columns iw_columns large-7" id="coll0697wjf"> <div class="iw_placeholder" id="iw_placeholder1646025728274"></div> </div> <div class="columns iw_columns large-1" id="coll0697wht"> <div></div> </div> <div class="columns iw_columns large-4" id="coll0697wic"> <div class="iw_placeholder" id="iw_placeholder1646025731834"></div> </div> </div> </div> <div class="iw_section" id="sectionl0697wim"> <div class="row iw_row iw_stretch" id="rowl0697win"> <div class="columns iw_columns large-12" id="coll0697wio"> <div class="iw_placeholder" id="iw_placeholder1646025731830"> <div class="iw_component" id="iw_comp1698403835988"> <style>#iw_comp1698403835988{}</style><div class="leaf-u-align-self-start"><chc-sticky-banner> <h4 slot="heading" class="leaf-u-typography-title-default">Building a new benefits package?</h4> <div slot="content"><a class="leaf-u-link--action leaf-u-link--no-underline" href="#ContactMeEloquaForm" data-modal-id="ContactMeEloquaForm">Ask to speak with a Cigna Healthcare representative</a></div> <div slot="form"></div> <div slot="callout"></div> </chc-sticky-banner></div> </div> </div> </div> </div> </div> <div class="iw_section" id="sectionl0697wii"> <div class="row iw_row iw_stretch" id="rowl0697wij"> <div class="columns iw_columns large-7" id="coll0697wik"> <div class="iw_placeholder" id="iw_placeholder1646025728278"></div> </div> <div class="columns iw_columns large-5" id="coll0697wgt"> <div class="iw_placeholder" id="iw_placeholder1646025728282"></div> </div> </div> </div> <div class="iw_section" id="sectionl0697wiq"> <div class="row iw_row iw_stretch" id="rowl0697wir"> <div class="columns iw_columns large-7" id="coll0697wis"> <div class="iw_placeholder" id="iw_placeholder1648192639294"> <div class="iw_component" id="iw_comp1698403835990"> <style>#iw_comp1698403835990{}</style><div class="leaf-c-content-block leaf-u-align-self-start"><h2>Products and Solutions for Third-Party Administrators</h2> <p>Some employers demand a higher level of customization and flexibility that aligns with the capabilities of a Third-Party Administrator (TPA). Partner with Payer Solutions, and you'll have access to a broad portfolio of products and services, quality health care networks, and personalized account support—backed by a global brand with more than <a href="https://www.thecignagroup.com/about-us/milestones" rel="nofollow noopener" target="_blank" class="leaf-u-link--external" data-link-text="" tabindex="0">200 years of health service experience</a>.</p> <p>As your collaborative and trusted partner, Payer Solutions from Cigna Healthcare<sup>SM</sup>* helps to drive employee health, lower employer costs, and support and enhance the unique value you bring to your customers.</p></div> </div> <div class="iw_component" id="iw_comp1698403835991"> <style>#iw_comp1698403835991{}</style><div class="leaf-c-content-block leaf-u-align-self-start"><h3>Payer Solutions Digital Toolkit</h3> <p>View our Digital Toolkit for more information about our solutions available to TPAs.</p></div> </div> </div> </div> <div class="columns iw_columns large-1" id="coll0697wgx"> <div></div> </div> <div class="columns iw_columns large-4" id="coll0697wht"> <div class="iw_placeholder" id="iw_placeholder1646025728286"></div> </div> </div> </div> <div class="iw_section" id="sectionln4txotr"> <div class="row iw_row iw_stretch" id="rowln4txots"> <div class="columns iw_columns large-12" id="colln4txott"> <div class="iw_placeholder" id="iw_placeholder1696005585134"> <div class="iw_component" id="iw_comp1698403835989"> <style>#iw_comp1698403835989{}</style><chc-row type="undefined" columns="2" class="leaf-u-margin-top-24 leaf-u-align-self-start"> <leaf-card variant="simple" decorationposition="left" textposition="left" interactive="true"> <h3 slot="heading"><a href="https://www.cignaproducer.com/payersolutions/" target="_blank" rel="noopener noreferrer" class="leaf-u-typography-unset leaf-u-link--external">Full Suite of Products</a></h3> <div slot="content">A broad portfolio of modular, flexible health products and services.</div> </leaf-card> <leaf-card variant="simple" decorationposition="left" textposition="left" interactive="true"> <h3 slot="heading"><a href="https://cignaproducer.com/toolkits/network-value/" target="_blank" rel="noopener noreferrer" class="leaf-u-typography-unset leaf-u-link--external">Medical Network</a></h3> <div slot="content">Help TPAs deliver what companies and employees need most in health care: quality and lower costs.</div> </leaf-card> <leaf-card variant="simple" decorationposition="left" textposition="left" interactive="true"> <h3 slot="heading"><a href="https://cignaproducer.com/toolkits/dental-value/ppo" target="_blank" rel="noopener noreferrer" class="leaf-u-typography-unset leaf-u-link--external">Dental Network</a></h3> <div slot="content">In addition to our medical network, some clients may also access our dental network.</div> </leaf-card> <leaf-card variant="simple" decorationposition="left" textposition="left" interactive="true"> <h3 slot="heading"><a href="http://www.cignaproducer.com/toolkits/network-value_OAP/#8" target="_blank" rel="noopener noreferrer" class="leaf-u-typography-unset leaf-u-link--external">Employer and Member Engagement Materials</a></h3> <div slot="content">Educate members so they can make better, more informed health care decisions.</div> </leaf-card> </chc-row> </div> <div class="iw_component" id="iw_comp1698403835986"> <style>#iw_comp1698403835986{}</style><chc-promo class="leaf-u-align-self-start" variant="simple" color="light-green" size="default" image-position="initial"> <h3 slot="heading">Together, we can build a solution that's right for you. </h3> <div slot="content">For more information, email <a href="mailto:PayerSolutions@Evernorth.com">PayerSolutions@Evernorth.com</a>.</div> </chc-promo> </div> <div class="iw_component" id="iw_comp1698403835987"> <style>#iw_comp1698403835987{}</style><div class="leaf-c-content-block "><leaf-divider variant="horizontal"></leaf-divider></div> </div> </div> </div> </div> </div> <div class="iw_section" id="sectionl0697wiy"> <div class="row iw_row iw_stretch" id="rowl0697wiz"> <div class="columns iw_columns large-6" id="coll0697wj0"> <div class="iw_placeholder" id="iw_placeholder1646025731838"> <div class="iw_component" id="iw_comp1698403835994"> <style>#iw_comp1698403835994{}</style><leaf-list class="leaf-u-align-self-start" columns="1"> <h3 class="leaf-u-color-content-brand-strong" slot="heading">You May Also Be Interested In:</h3> <li><a href="/employers/business-types#state-local-governments" target="_self">Plans for State and Local Government</a></li> <li><a href="/employers/business-types#k-12" target="_self">Plans for K-12 School Districts</a></li> <li><a href="/employers/business-types#higher-education" target="_self">Plans for Higher Education Employers</a></li> <li><a href="/employers/business-types" target="_self" class="leaf-u-link--action leaf-u-link--no-underline">View all business types</a></li> </leaf-list> </div> </div> </div> <div class="columns iw_columns large-6" id="coll0697wj4"> <div class="iw_placeholder" id="iw_placeholder1646025731842"> <div class="iw_component" id="iw_comp1698403835992"> <style>#iw_comp1698403835992{}</style><leaf-list class="leaf-u-align-self-start" columns="1"> <h3 class="leaf-u-color-content-brand-strong" slot="heading">Explore All Products</h3> <li><a href="/employers/medical-plans/" target="_self">Medical Plans</a></li> <li><a href="/employers/pharmacy/" target="_self">Pharmacy</a></li> <li><a href="/employers/health-wellness-programs" target="_self">Health and Wellness Programs</a></li> <li><a href="/employers/behavioral-health" target="_self">Behavioral Health Programs</a></li> <li><a href="/employers/dental-and-vision/" target="_self">Dental and Vision</a></li> <li><a href="/employers/additional-insurance/" target="_self">Supplemental Health Solutions</a></li> <li><a href="/employers/savings-spending-accounts/" target="_self">Health Savings and Spending Accounts</a></li> <li><a href="/employers/cost-control/" target="_self">Cost Control Strategies</a></li> </leaf-list> </div> </div> </div> </div> </div> <div class="iw_section" id="sectionl0697wj6"> <div class="row iw_row iw_stretch" id="rowl0697wj7"> <div class="columns iw_columns large-7" id="coll0697wj8"> <div class="iw_placeholder" id="iw_placeholder1646025731846"> <div class="iw_component" id="iw_comp1698403835993"> <style>#iw_comp1698403835993{}</style><div class="leaf-c-content-block leaf-u-align-self-start"><div class="leaf-u-typography-body-small"> <p><strong><sup>*</sup>Offered by Cigna Health and Life Insurance Company or its affiliates</strong></p> <p><a href="/legal/compliance/cigna-company-names" rel="nofollow" class="leaf-u-link" tabindex="0">View Cigna Healthcare Company Names</a></p> <p>© <leaf-datetime format="%Y">2023</leaf-datetime> Cigna Healthcare.</p> </div></div> </div> </div> </div> <div class="columns iw_columns large-1" id="coll0697wh1"> <div></div> </div> <div class="columns 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class="leaf-u-typography-title-xlarge">Let's Get Started</h2> <div><p>Thank you for your interest in Cigna Healthcare. Please provide some basic information about your company and a representative will contact you.</p> <form action="https://s1399.t.eloqua.com/e/f2" name="O_Cignacom_022618_LeadGen_ContactMeForm" accept-charset="UTF-8" enctype="multipart/form-data" method="POST" target="_self"> <leaf-input name="elqFormName" type="hidden" value="O_Cignacom_022618_LeadGen_ContactMeForm"> </leaf-input> <leaf-input name="elqSiteId" type="hidden" value="1399"> </leaf-input> <leaf-input name="CampaignName" type="hidden" value="O_Cignacom_032718_LeadGen_Contact_Me_Form"> </leaf-input> <leaf-input name="CampaignID" type="hidden" value="70139000001NTZw"> </leaf-input> <leaf-input name="InternalDepartment" type="hidden" value="Lead Gen Insights Prospecting"> </leaf-input> <leaf-input name="address1" type="hidden" value=""> </leaf-input> <leaf-label for="contact-me-fname">First Name</leaf-label> <leaf-input autocomplete="given-name" name="firstName" required type="text" id="contact-me-fname"></leaf-input> <leaf-label for="contact-me-lname">Last Name</leaf-label> <leaf-input autocomplete="family-name" name="lastName" required type="text" id="contact-me-lname"></leaf-input> <leaf-label for="contact-me-email">Email Address</leaf-label> <leaf-input autocomplete="email" name="emailAddress" required type="email" id="contact-me-email"></leaf-input> <leaf-label for="contact-me-company">Company</leaf-label> <leaf-input autocomplete="on" name="company" required type="text" id="contact-me-company"> </leaf-input> <leaf-label for="contact-me-city">City</leaf-label> <leaf-input autocomplete="address-level2" name="city" required type="text" id="contact-me-city"> </leaf-input> <leaf-label for="contact-me-state">State</leaf-label> <leaf-select autocomplete="address-level1" name="stateProv" required id="contact-me-state"> <leaf-select-option disabled value selected>Choose a State</leaf-select-option> <leaf-select-option value="AL">Alabama</leaf-select-option> <leaf-select-option value="AK">Alaska</leaf-select-option> <leaf-select-option value="AZ">Arizona</leaf-select-option> <leaf-select-option value="AR">Arkansas</leaf-select-option> <leaf-select-option value="CA">California</leaf-select-option> <leaf-select-option value="CO">Colorado</leaf-select-option> <leaf-select-option value="CT">Connecticut</leaf-select-option> <leaf-select-option value="DE">Delaware</leaf-select-option> <leaf-select-option value="DC">District Of Columbia</leaf-select-option> <leaf-select-option value="FL">Florida</leaf-select-option> <leaf-select-option value="GA">Georgia</leaf-select-option> <leaf-select-option value="HI">Hawaii</leaf-select-option> <leaf-select-option value="ID">Idaho</leaf-select-option> <leaf-select-option value="IL">Illinois</leaf-select-option> <leaf-select-option value="IN">Indiana</leaf-select-option> <leaf-select-option value="IA">Iowa</leaf-select-option> <leaf-select-option value="KS">Kansas</leaf-select-option> <leaf-select-option value="KY">Kentucky</leaf-select-option> <leaf-select-option value="LA">Louisiana</leaf-select-option> <leaf-select-option value="ME">Maine</leaf-select-option> <leaf-select-option value="MD">Maryland</leaf-select-option> <leaf-select-option value="MA">Massachusetts</leaf-select-option> <leaf-select-option value="MI">Michigan</leaf-select-option> <leaf-select-option value="MN">Minnesota</leaf-select-option> <leaf-select-option value="MS">Mississippi</leaf-select-option> <leaf-select-option value="MO">Missouri</leaf-select-option> <leaf-select-option value="MT">Montana</leaf-select-option> <leaf-select-option value="NE">Nebraska</leaf-select-option> <leaf-select-option value="NV">Nevada</leaf-select-option> <leaf-select-option value="NH">New Hampshire</leaf-select-option> <leaf-select-option value="NJ">New Jersey</leaf-select-option> <leaf-select-option value="NM">New Mexico</leaf-select-option> <leaf-select-option value="NY">New York</leaf-select-option> <leaf-select-option value="NC">North Carolina</leaf-select-option> <leaf-select-option value="ND">North Dakota</leaf-select-option> <leaf-select-option value="OH">Ohio</leaf-select-option> <leaf-select-option value="OK">Oklahoma</leaf-select-option> <leaf-select-option value="OR">Oregon</leaf-select-option> <leaf-select-option value="PA">Pennsylvania</leaf-select-option> <leaf-select-option value="RI">Rhode Island</leaf-select-option> <leaf-select-option value="SC">South Carolina</leaf-select-option> <leaf-select-option value="SD">South Dakota</leaf-select-option> <leaf-select-option value="TN">Tennessee</leaf-select-option> <leaf-select-option value="TX">Texas</leaf-select-option> <leaf-select-option value="UT">Utah</leaf-select-option> <leaf-select-option value="VT">Vermont</leaf-select-option> <leaf-select-option value="VA">Virginia</leaf-select-option> <leaf-select-option value="WA">Washington</leaf-select-option> <leaf-select-option value="WV">West Virginia</leaf-select-option> <leaf-select-option value="WI">Wisconsin</leaf-select-option> <leaf-select-option value="WY">Wyoming</leaf-select-option> <leaf-select-option disabled value="canadian-territories">------</leaf-select-option> <leaf-select-option value="AB">Alberta</leaf-select-option> <leaf-select-option value="BC">British Columbia</leaf-select-option> <leaf-select-option value="MB">Manitoba</leaf-select-option> <leaf-select-option value="NB">New Brunswick</leaf-select-option> <leaf-select-option value="NL">Newfoundland and Labrador</leaf-select-option> <leaf-select-option value="NS">Nova Scotia</leaf-select-option> <leaf-select-option value="ON">Ontario</leaf-select-option> <leaf-select-option value="PE">Prince Edward Island</leaf-select-option> <leaf-select-option value="SK">Saskatchewan</leaf-select-option> <leaf-select-option value="QB">Quebec</leaf-select-option> <leaf-select-option disabled value="other-territories">------</leaf-select-option> <leaf-select-option value="AS">American Samoa</leaf-select-option> <leaf-select-option value="GU">Guam</leaf-select-option> <leaf-select-option value="FM">Federated States Of Micronesia</leaf-select-option> <leaf-select-option value="MH">Marshall Islands</leaf-select-option> <leaf-select-option value="MP">Northern Mariana Islands</leaf-select-option> <leaf-select-option value="AA">Military Americas</leaf-select-option> <leaf-select-option value="AE">Military Europe/ME/Canada</leaf-select-option> <leaf-select-option value="AP">Military Pacific</leaf-select-option> <leaf-select-option value="NW">Northwest Territories</leaf-select-option> <leaf-select-option value="NU">Nunavut</leaf-select-option> <leaf-select-option value="PW">Palau</leaf-select-option> <leaf-select-option value="PR">Puerto Rico</leaf-select-option> <leaf-select-option value="VI">Virgin Islands</leaf-select-option> <leaf-select-option value="YT">Yukon Territory</leaf-select-option> </leaf-select> <leaf-label for="contact-me-zip">Zip Code</leaf-label> <leaf-input autocomplete="postal-code" placeholder="00000-0000" name="zipPostal" required type="tel" id="contact-me-zip" pattern="^\d{5}(?:[-\s]\d{4})?$"> <span slot="note">12345 or 12345-2345</span> </leaf-input> <leaf-label for="contact-me-country">Country</leaf-label> <leaf-select autocomplete="country" name="Country" required id="contact-me-country"> <leaf-select-option selected disabled value>Choose a Country</leaf-select-option> <leaf-select-option value="US">United States</leaf-select-option> <leaf-select-option value="CA">Canada</leaf-select-option> <leaf-select-option value="GB">United Kingdom</leaf-select-option> <leaf-select-option disabled value="spacer">------------</leaf-select-option> <leaf-select-option value="AD">Andorra</leaf-select-option> <leaf-select-option value="AE">United Arab Emirates</leaf-select-option> <leaf-select-option value="AF">Afghanistan</leaf-select-option> <leaf-select-option value="AG">Antigua and Barbuda</leaf-select-option> <leaf-select-option value="AI">Anguilla</leaf-select-option> <leaf-select-option value="AL">Albania</leaf-select-option> <leaf-select-option value="AM">Armenia</leaf-select-option> <leaf-select-option value="AO">Angola</leaf-select-option> <leaf-select-option value="AQ">Antarctica</leaf-select-option> <leaf-select-option value="AR">Argentina</leaf-select-option> <leaf-select-option value="AS">American Samoa</leaf-select-option> <leaf-select-option value="AT">Austria</leaf-select-option> <leaf-select-option value="AU">Australia</leaf-select-option> <leaf-select-option value="AW">Aruba</leaf-select-option> <leaf-select-option value="AX">Aland Islands</leaf-select-option> <leaf-select-option value="AZ">Azerbaijan</leaf-select-option> <leaf-select-option value="BA">Bosnia and Herzegovina</leaf-select-option> <leaf-select-option value="BB">Barbados</leaf-select-option> <leaf-select-option value="BD">Bangladesh</leaf-select-option> <leaf-select-option value="BE">Belgium</leaf-select-option> <leaf-select-option value="BF">Burkina Faso</leaf-select-option> <leaf-select-option value="BG">Bulgaria</leaf-select-option> <leaf-select-option value="BH">Bahrain</leaf-select-option> <leaf-select-option value="BI">Burundi</leaf-select-option> <leaf-select-option value="BJ">Benin</leaf-select-option> <leaf-select-option value="BL">Saint Barthelemy</leaf-select-option> <leaf-select-option value="BM">Bermuda</leaf-select-option> <leaf-select-option value="BN">Brunei</leaf-select-option> <leaf-select-option value="BO">Bolivia</leaf-select-option> <leaf-select-option value="BQ">Bonaire, Saint Eustatius and Saba </leaf-select-option> <leaf-select-option value="BR">Brazil</leaf-select-option> <leaf-select-option value="BS">Bahamas</leaf-select-option> <leaf-select-option value="BT">Bhutan</leaf-select-option> <leaf-select-option value="BV">Bouvet Island</leaf-select-option> <leaf-select-option value="BW">Botswana</leaf-select-option> <leaf-select-option value="BY">Belarus</leaf-select-option> <leaf-select-option value="BZ">Belize</leaf-select-option> <leaf-select-option value="CC">Cocos Islands</leaf-select-option> <leaf-select-option value="CD">Democratic Republic of the Congo</leaf-select-option> <leaf-select-option value="CF">Central African Republic</leaf-select-option> <leaf-select-option value="CG">Republic of the Congo</leaf-select-option> <leaf-select-option value="CH">Switzerland</leaf-select-option> <leaf-select-option value="CI">Ivory Coast</leaf-select-option> <leaf-select-option value="CK">Cook Islands</leaf-select-option> <leaf-select-option value="CL">Chile</leaf-select-option> <leaf-select-option value="CM">Cameroon</leaf-select-option> <leaf-select-option value="CN">China</leaf-select-option> <leaf-select-option value="CO">Colombia</leaf-select-option> <leaf-select-option value="CR">Costa Rica</leaf-select-option> <leaf-select-option value="CU">Cuba</leaf-select-option> <leaf-select-option value="CV">Cape Verde</leaf-select-option> <leaf-select-option value="CW">Curacao</leaf-select-option> <leaf-select-option value="CX">Christmas Island</leaf-select-option> <leaf-select-option value="CY">Cyprus</leaf-select-option> <leaf-select-option value="CZ">Czech Republic</leaf-select-option> <leaf-select-option value="DE">Germany</leaf-select-option> <leaf-select-option value="DJ">Djibouti</leaf-select-option> <leaf-select-option value="DK">Denmark</leaf-select-option> <leaf-select-option value="DM">Dominica</leaf-select-option> <leaf-select-option value="DO">Dominican Republic</leaf-select-option> <leaf-select-option value="DZ">Algeria</leaf-select-option> <leaf-select-option value="EC">Ecuador</leaf-select-option> <leaf-select-option value="EE">Estonia</leaf-select-option> <leaf-select-option value="EG">Egypt</leaf-select-option> <leaf-select-option value="EH">Western Sahara</leaf-select-option> <leaf-select-option value="ER">Eritrea</leaf-select-option> <leaf-select-option value="ES">Spain</leaf-select-option> <leaf-select-option value="ET">Ethiopia</leaf-select-option> <leaf-select-option value="FI">Finland</leaf-select-option> <leaf-select-option value="FJ">Fiji</leaf-select-option> <leaf-select-option value="FK">Falkland Islands</leaf-select-option> <leaf-select-option value="FM">Micronesia</leaf-select-option> <leaf-select-option value="FO">Faroe Islands</leaf-select-option> <leaf-select-option value="FR">France</leaf-select-option> <leaf-select-option value="GA">Gabon</leaf-select-option> <leaf-select-option value="GD">Grenada</leaf-select-option> <leaf-select-option value="GE">Georgia</leaf-select-option> <leaf-select-option value="GF">French Guiana</leaf-select-option> <leaf-select-option value="GG">Guernsey</leaf-select-option> <leaf-select-option value="GH">Ghana</leaf-select-option> <leaf-select-option value="GI">Gibraltar</leaf-select-option> <leaf-select-option value="GL">Greenland</leaf-select-option> <leaf-select-option value="GM">Gambia</leaf-select-option> <leaf-select-option value="GN">Guinea</leaf-select-option> <leaf-select-option value="GP">Guadeloupe</leaf-select-option> <leaf-select-option value="GQ">Equatorial Guinea</leaf-select-option> <leaf-select-option value="GR">Greece</leaf-select-option> <leaf-select-option value="GS">South Georgia and the South Sandwich Islands</leaf-select-option> <leaf-select-option value="GT">Guatemala</leaf-select-option> <leaf-select-option value="GU">Guam</leaf-select-option> <leaf-select-option value="GW">Guinea-Bissau</leaf-select-option> <leaf-select-option value="GY">Guyana</leaf-select-option> <leaf-select-option value="HK">Hong Kong</leaf-select-option> <leaf-select-option value="HM">Heard Island and McDonald Islands</leaf-select-option> <leaf-select-option value="HN">Honduras</leaf-select-option> <leaf-select-option value="HR">Croatia</leaf-select-option> <leaf-select-option value="HT">Haiti</leaf-select-option> <leaf-select-option value="HU">Hungary</leaf-select-option> <leaf-select-option value="ID">Indonesia</leaf-select-option> <leaf-select-option value="IE">Ireland</leaf-select-option> <leaf-select-option value="IL">Israel</leaf-select-option> <leaf-select-option value="IM">Isle of Man</leaf-select-option> <leaf-select-option value="IN">India</leaf-select-option> <leaf-select-option value="IO">British Indian Ocean Territory</leaf-select-option> <leaf-select-option value="IQ">Iraq</leaf-select-option> <leaf-select-option value="IR">Iran</leaf-select-option> <leaf-select-option value="IS">Iceland</leaf-select-option> <leaf-select-option value="IT">Italy</leaf-select-option> <leaf-select-option value="JE">Jersey</leaf-select-option> <leaf-select-option value="JM">Jamaica</leaf-select-option> <leaf-select-option value="JO">Jordan</leaf-select-option> <leaf-select-option value="JP">Japan</leaf-select-option> <leaf-select-option value="KE">Kenya</leaf-select-option> <leaf-select-option value="KG">Kyrgyzstan</leaf-select-option> <leaf-select-option value="KH">Cambodia</leaf-select-option> <leaf-select-option value="KI">Kiribati</leaf-select-option> <leaf-select-option value="KM">Comoros</leaf-select-option> <leaf-select-option value="KN">Saint Kitts and Nevis</leaf-select-option> <leaf-select-option value="KP">North Korea</leaf-select-option> <leaf-select-option value="KR">South Korea</leaf-select-option> <leaf-select-option value="KW">Kuwait</leaf-select-option> <leaf-select-option value="KY">Cayman Islands</leaf-select-option> <leaf-select-option value="KZ">Kazakhstan</leaf-select-option> <leaf-select-option value="LA">Laos</leaf-select-option> <leaf-select-option value="LB">Lebanon</leaf-select-option> <leaf-select-option value="LC">Saint Lucia</leaf-select-option> <leaf-select-option value="LI">Liechtenstein</leaf-select-option> <leaf-select-option value="LK">Sri Lanka</leaf-select-option> <leaf-select-option value="LR">Liberia</leaf-select-option> <leaf-select-option value="LS">Lesotho</leaf-select-option> <leaf-select-option value="LT">Lithuania</leaf-select-option> <leaf-select-option value="LU">Luxembourg</leaf-select-option> <leaf-select-option value="LV">Latvia</leaf-select-option> <leaf-select-option value="LY">Libya</leaf-select-option> <leaf-select-option value="MA">Morocco</leaf-select-option> <leaf-select-option value="MC">Monaco</leaf-select-option> <leaf-select-option value="MD">Moldova</leaf-select-option> <leaf-select-option value="ME">Montenegro</leaf-select-option> <leaf-select-option value="MF">Saint Martin</leaf-select-option> <leaf-select-option value="MG">Madagascar</leaf-select-option> <leaf-select-option value="MH">Marshall Islands</leaf-select-option> <leaf-select-option value="MK">Macedonia</leaf-select-option> <leaf-select-option value="ML">Mali</leaf-select-option> <leaf-select-option value="MM">Myanmar</leaf-select-option> <leaf-select-option value="MN">Mongolia</leaf-select-option> <leaf-select-option value="MO">Macao</leaf-select-option> <leaf-select-option value="MP">Northern Mariana Islands</leaf-select-option> <leaf-select-option value="MQ">Martinique</leaf-select-option> <leaf-select-option value="MR">Mauritania</leaf-select-option> <leaf-select-option value="MS">Montserrat</leaf-select-option> <leaf-select-option value="MT">Malta</leaf-select-option> <leaf-select-option value="MU">Mauritius</leaf-select-option> <leaf-select-option value="MV">Maldives</leaf-select-option> <leaf-select-option value="MW">Malawi</leaf-select-option> <leaf-select-option value="MX">Mexico</leaf-select-option> <leaf-select-option value="MY">Malaysia</leaf-select-option> <leaf-select-option value="MZ">Mozambique</leaf-select-option> <leaf-select-option value="NA">Namibia</leaf-select-option> <leaf-select-option value="NC">New Caledonia</leaf-select-option> <leaf-select-option value="NE">Niger</leaf-select-option> <leaf-select-option value="NF">Norfolk Island</leaf-select-option> <leaf-select-option value="NG">Nigeria</leaf-select-option> <leaf-select-option value="NI">Nicaragua</leaf-select-option> <leaf-select-option value="NL">Netherlands</leaf-select-option> <leaf-select-option value="NO">Norway</leaf-select-option> <leaf-select-option value="NP">Nepal</leaf-select-option> <leaf-select-option value="NR">Nauru</leaf-select-option> <leaf-select-option value="NU">Niue</leaf-select-option> <leaf-select-option value="NZ">New Zealand</leaf-select-option> <leaf-select-option value="OM">Oman</leaf-select-option> <leaf-select-option value="PA">Panama</leaf-select-option> <leaf-select-option value="PE">Peru</leaf-select-option> <leaf-select-option value="PF">French Polynesia</leaf-select-option> <leaf-select-option value="PG">Papua New Guinea</leaf-select-option> <leaf-select-option value="PH">Philippines</leaf-select-option> <leaf-select-option value="PK">Pakistan</leaf-select-option> <leaf-select-option value="PL">Poland</leaf-select-option> <leaf-select-option value="PM">Saint Pierre and Miquelon</leaf-select-option> <leaf-select-option value="PN">Pitcairn</leaf-select-option> <leaf-select-option value="PR">Puerto Rico</leaf-select-option> <leaf-select-option value="PS">Palestinian Territory</leaf-select-option> <leaf-select-option value="PT">Portugal</leaf-select-option> <leaf-select-option value="PW">Palau</leaf-select-option> <leaf-select-option value="PY">Paraguay</leaf-select-option> <leaf-select-option value="QA">Qatar</leaf-select-option> <leaf-select-option value="RE">Reunion</leaf-select-option> <leaf-select-option value="RO">Romania</leaf-select-option> <leaf-select-option value="RS">Serbia</leaf-select-option> <leaf-select-option value="RU">Russia</leaf-select-option> <leaf-select-option value="RW">Rwanda</leaf-select-option> <leaf-select-option value="SA">Saudi Arabia</leaf-select-option> <leaf-select-option value="SB">Solomon Islands</leaf-select-option> <leaf-select-option value="SC">Seychelles</leaf-select-option> <leaf-select-option value="SD">Sudan</leaf-select-option> <leaf-select-option value="SE">Sweden</leaf-select-option> <leaf-select-option value="SG">Singapore</leaf-select-option> <leaf-select-option value="SH">Saint Helena</leaf-select-option> <leaf-select-option value="SI">Slovenia</leaf-select-option> <leaf-select-option value="SJ">Svalbard and Jan Mayen</leaf-select-option> <leaf-select-option value="SK">Slovakia</leaf-select-option> <leaf-select-option value="SL">Sierra Leone</leaf-select-option> <leaf-select-option value="SM">San Marino</leaf-select-option> <leaf-select-option value="SN">Senegal</leaf-select-option> <leaf-select-option value="SO">Somalia</leaf-select-option> <leaf-select-option value="SR">Suriname</leaf-select-option> <leaf-select-option value="SS">South Sudan</leaf-select-option> <leaf-select-option value="ST">Sao Tome and Principe</leaf-select-option> <leaf-select-option value="SV">El Salvador</leaf-select-option> <leaf-select-option value="SX">Sint Maarten</leaf-select-option> <leaf-select-option value="SY">Syria</leaf-select-option> <leaf-select-option value="SZ">Swaziland</leaf-select-option> <leaf-select-option value="TC">Turks and Caicos Islands</leaf-select-option> <leaf-select-option value="TD">Chad</leaf-select-option> <leaf-select-option value="TF">French Southern Territories</leaf-select-option> <leaf-select-option value="TG">Togo</leaf-select-option> <leaf-select-option value="TH">Thailand</leaf-select-option> <leaf-select-option value="TJ">Tajikistan</leaf-select-option> <leaf-select-option value="TK">Tokelau</leaf-select-option> <leaf-select-option value="TL">East Timor</leaf-select-option> <leaf-select-option value="TM">Turkmenistan</leaf-select-option> <leaf-select-option value="TN">Tunisia</leaf-select-option> <leaf-select-option value="TO">Tonga</leaf-select-option> <leaf-select-option value="TR">Turkey</leaf-select-option> <leaf-select-option value="TT">Trinidad and Tobago</leaf-select-option> <leaf-select-option value="TV">Tuvalu</leaf-select-option> <leaf-select-option value="TW">Taiwan</leaf-select-option> <leaf-select-option value="TZ">Tanzania</leaf-select-option> <leaf-select-option value="UA">Ukraine</leaf-select-option> <leaf-select-option value="UG">Uganda</leaf-select-option> <leaf-select-option value="UM">United States Minor Outlying Islands</leaf-select-option> <leaf-select-option value="UY">Uruguay</leaf-select-option> <leaf-select-option value="UZ">Uzbekistan</leaf-select-option> <leaf-select-option value="VA">Vatican</leaf-select-option> <leaf-select-option value="VC">Saint Vincent and the Grenadines</leaf-select-option> <leaf-select-option value="VE">Venezuela</leaf-select-option> <leaf-select-option value="VG">British Virgin Islands</leaf-select-option> <leaf-select-option value="VI">U.S. Virgin Islands</leaf-select-option> <leaf-select-option value="VN">Vietnam</leaf-select-option> <leaf-select-option value="VU">Vanuatu</leaf-select-option> <leaf-select-option value="WF">Wallis and Futuna</leaf-select-option> <leaf-select-option value="WS">Samoa</leaf-select-option> <leaf-select-option value="XK">Kosovo</leaf-select-option> <leaf-select-option value="YE">Yemen</leaf-select-option> <leaf-select-option value="YT">Mayotte</leaf-select-option> <leaf-select-option value="ZA">South Africa</leaf-select-option> <leaf-select-option value="ZM">Zambia</leaf-select-option> <leaf-select-option value="ZW">Zimbabwe</leaf-select-option> </leaf-select> <leaf-label for="contact-me-iam">I am a(n):</leaf-label> <leaf-select autocomplete="on" name="role" required id="contact-me-iam"> <leaf-select-option value selected disabled>Select...</leaf-select-option> <leaf-select-option value="Seeking coverage for myself and/or my family">Seeking coverage for myself and/or my family</leaf-select-option> <leaf-select-option value="Seeking coverage for my small business (<25 employees)"> Seeking coverage for my small business 25 employees </leaf-select-option> <leaf-select-option value="Employer looking to offer coverage through Cigna">Employer looking to offer coverage through Cigna</leaf-select-option> <leaf-select-option value="Employer with international presence looking for information about Cigna benefits">Employer with international presence looking for information about Cigna benefits</leaf-select-option> <leaf-select-option value="Employee of a company who currently has Cigna benefits">Employee of a company who currently has Cigna benefits</leaf-select-option> <leaf-select-option value="Employer currently offering Cigna">Employer currently offering Cigna</leaf-select-option> <leaf-select-option value="Broker who is looking to quote Cigna">Broker who is looking to quote Cigna</leaf-select-option> <leaf-select-option value="Other (please explain)">Other (please explain)</leaf-select-option> </leaf-select> <leaf-label for="contact-me-other">If you chose "Other" above, please explain:</leaf-label> <leaf-input autocomplete="on" name="other" type="text" id="contact-me-other"> </leaf-input> <leaf-label for="contact-me-empsize">Employee Size</leaf-label> <leaf-select autocomplete="on" name="dropdownMenu" required id="contact-me-empsize"> <leaf-select-option value selected disabled>Select...</leaf-select-option> <leaf-select-option value="1-2">1-2</leaf-select-option> <leaf-select-option value="3-10">3-10</leaf-select-option> <leaf-select-option value="11-24">11-24</leaf-select-option> <leaf-select-option value="25-50">25-50</leaf-select-option> <leaf-select-option value="51-99">51-99</leaf-select-option> <leaf-select-option value="100-249">100-249</leaf-select-option> <leaf-select-option value="250-499">250-499</leaf-select-option> <leaf-select-option value="500-4,999">500-4,999</leaf-select-option> <leaf-select-option value="5,000+">5,000+</leaf-select-option> <leaf-select-option value="5,000+ multiple states">5,000+ multiple states</leaf-select-option> </leaf-select> <leaf-label for="contact-me-phone">Business Phone</leaf-label> <leaf-input autocomplete="tel" name="busPhone" type="tel" required id="contact-me-phone" pattern="[+]?[0-9- ]{0,14}$"> <span slot="note">+1 123 456 5678</span> </leaf-input> <p> I consent to receive calls or texts from Cigna and its affiliates that may deliver an autodialed or prerecorded telemarketing message at the phone number provided above. 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