Prospects with 35 to 100 Lives:

• Prospect name
• Location (city, state, zip)
• Are any employees at other locations? If yes, where?
• Nature of the prospect's business (industry)
• Employer contributions
• Current carrier
• Prior carrier (if less than 3 years with current)
• Renewal date and proposed effective date
• Date proposal needed
• Current and renewal rates (if renewal rates are unavailable, then provider prior rate history)
• Requested plan of benefits
• Copy of current plan of benefits
• Requested life benefit
• Census in Excel format (gender, date of birth, dependent coverage, zip codes and life volumes)
• Information on any large, ongoing claims (amounts, diagnoses and prognoses)
• 1 to 2 years of claims experience.
  

Additional Information Needed for Current Self-funded Accounts and Groups of 100 or More Lives:

• 2 years (current and prior year) of monthly claims experience and coinciding monthly enrollment.
• Shock loss data for current year and prior year. (Total amount paid, diagnosis, prognosis, etc.)
• Rate history for experience periods
• Current Specific deductible and contract types (if currently self-funded)

Please send the above information to the address below: