GUIDELINES: What to include in your request for a Partially Self-Funded Quote
Minimum (If under 150 employees) - Proposal Request Form (Printable Version)
- Group Demographics - name, headquarters and its address, other locations, nature of business.
- Employee Census - gender, date of birth, date of hire, present coverage status (i.e. employee only, employee + spouse, etc.). If want us to search for a PPO by area, then zip codes are a must.
- Present Rates (if self-funded specific and aggregate premium and aggregate factors or if conventionally insured the premium)
- If presently self-funded or covered under a conventionally insured PPO type program (non-HMO): Claims Experience by month & Month-by-month enrollment - at least 12 months worth and more if available.
Or
- If presently HMO: Rate history and/or loss ratio history for as many of the past consecutive years that might be available.
Complimentary
- If presently self-funded: A copy of the Schedule of Insurance from
the Stop Loss Contract (What we're after is the claim basis for the
specific and aggregate 12/12 or 12/15 etc. and the aggregate factors.
More is better so if past years records are available - good).
- If presently self-funded - who is their PPO, prescription card, stop-loss
insurer?
- Summary Plan Description or Plan Document - Complete copy or at least
a copy of the Schedule of Benefits page.
- Shock Claims - Any knowledge of ongoing, large or chronic claims, or based on a medical condition, future large claim(s).
Call us if you have any questions.