General Information

First we start by gathering your Company Name, Industry Type (SIC Code), Location(s), Number of Employees (S/F), Desired Specific Deductible(s), Contract Basis, Commissions Required, Effective Date, Aggregate Coverage Required and what benefits, and any miscellaneous request.

Census Info

• Names

• Date of Birth

• Gender

• Single, EE/SP, EE/CH, Family Medical Coverage

• Benefit plan election

• Zip Codes if more than one location

• Include dependent info (Member level census)

Itemization of Stock Claims

• Individuals with claims in excess of the Specific Deductible over the past three policy periods (minimum two years required).

• The most recent policy period should also include information on individuals with the potential to exceed the lowest Specific Deductible.

• The most recent policy period should include claim details – diagnosis, prognosis, and future treatment.

Plan Document or Schedule of Current & Proposed Benefits

• Current / Proposed

Aggregated Quote (If Required)

• At least the most recent NINE months of MONTHLY paid claims and corresponding enrollment figures, PLUS

• The PRIOR 12 months of MONTHLY paid claims and corresponding enrollment figures.

*Fully Insured Cases moving to Self-Funded

• Normal Information needed to quote (census, benefit designs, SIC code, etc...) plus claims experience must be provided if available (state/carrier specific).

• Fully insured current rates and renewal rates (excel format-see below) are required. Note: Quote can be issued with only current rates but will be subject to receiving renewal rates.