Information Required for a Quote

25 or More Covered Lives 

• Account Information:
  
  • Account Name
  • Account Address
  • Requested Effective Date
  • Due Date
  • Bid Strategy/Reason Out to Bid
  • 5-Year Carrier History (Carrier Name/Number of Years) 

• Locations:

• Where company headquartered
• Where benefits are administered
• Where employees are located 

• Census: (Must include - Excel format preferred)

• Eligible Employees
• Age or Date of Birth
• Gender
• Tier Structure (Single, Employee + 1, Family, etc.)
• Employee Zip Code or Address with City, State & Zip
• Plan Election (if more than one medical/dental product are offered)
• Total number of employees on benefit plan
• Volume (for life, disability, etc.)
• Employee Classification (Hourly/Salary, Union/Non-Union, Retiree, etc.) 

• Plan Design Information:

• Current carrier
• Current renewal date
• Current premium rates (if currently insured)
• Current specific/aggregate rates (if currently self-funded)
• Renewal premium rates (if currently insured)
• Renewal specific/aggregate rates (if currently self-funded)
• Copy of current plan design
• Requested changes to current design
• Eligibility requirements 

• Claims Experience:

• Monthly enrollment and claims experience, by plan for the most recent 24 months
• For claims greater than $25,000 or >50% of specific stop loss attachment point during the experience period, include dollar amount, diagnosis and claim status (active/resolved) and prognosis. 

• Rates/Fees: (Current and Renewal)

• List administration fees, specific and aggregate stop loss rates and claim factors
• Specify if rates and fees includes commissions 

• Current Network(s)