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Information
needed to prepare a quote
Authorization to Quote -
if not the current broker of record. Please provide
the following for an
Administrative Services Proposal
- List of Administrative Services desired
| Single-source Billing |
Electronic Enrollment |
| Self-funded
Medical |
Flexible
Spending Accounts: |
| Self-funded
Prescription |
Section
125 POP and Medical Expense |
| Self-funded
Vision |
Section
129 Dependent Care |
| Self-funded
Dental |
Section
132 CERA Transportation |
| Advice to
pay Short-term disability |
HRA |
- Client name
and corporate address. If there are multiple locations, please
list city and state and number of employees at each. Number of
eligible and enrolled employees. Effective date of administration
services
- Name of current provider of services and current fees
Excess Loss Proposal
- Information
above for administrative services. Aggregate claims history for
current and prior two plan years. Large claim report. Group census
of eligible employees including gender, date of hire, date
of enrollment, COBRA start and term date, enrollment status,
employee city, state and zip. Current excess loss carrier name,
contract type (e.g., 24/12), specific deductible, specific
and aggregate premium rates, aggregate factors, contract options
(e.g., monthly aggregate accommodation, terminal liability). Please
indicate which plans are covered under specific and aggregate
(e.g., medical, prescription, dental, vision). Fully-insured groups
provide current and prior two years’ plan
rates, plus claims experience above. Current and desired plan design
options.
- Current and desired PPO networks
- Current and desired Pharmacy Benefit Manager
We have markets
for excess loss coverage beginning at 35 lives.
Please note: fully-insured groups desiring to purchase excess
loss coverage for a self-funded medical plan will receive most competitive
underwriting with claims experience. Fully-insured groups
without access to claims data can be quoted, but rates may be higher.
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