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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)


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Toll free: 888-646-2429
Local: 989-839-1629
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