In order to process a request for a quote rapidly and accurately, please forward the following information at your earliest convenience. Please send all information in an electronic format, if available.
For Specific Excess:
- Name of account, city, state and zip code to site group.
- Please provide a complete census, which includes type of coverage, gender, zip code and age/date of birth. Please also identify any retirees; and if they are covered, please indicate whether Medicare is primary or secondary. Also include retiree eligibility requirements.
- Please include the zip code breakdown if you have multiple locations and describe nature of business (SIC Code).
- Large loss reports which show current contract year and previous contract year claims in excess of 50% of the specific deductible including to/from paid dates and diagnosis/prognosis. Also include a list of any member that is currently disabled, on COBRA or on waiver of premium benefits.
- A copy of the self-funded plan document(s) or plan summary(s) of benefits, name of current TPA, and name(s) of current or proposed PPO networks. Include any proposed plan design changes.
- Current stop loss carrier, rates, deductible level, contract type (i.e., 12/12, 12/15, 15/12, PAID, etc.), effective date and any contract limitations or exclusions.
- Please indicate if specific coverage currently includes additional products other than medical only (i.e. dental, vision, prescription drugs), and include relevant plan documents and historical claims data.
- Requested quote options; effective date, deductibles, contract types, coverages (med/rx/etc), maximum liability and quote deadline.
- A copy of the current stop loss policy schedule along with the renewal proposal (if available).
For Aggregate Excess:
- Type of Contract requested (i.e., 12/12, 12/15, 15/12, PAID, etc.).
- Monthly paid claims and monthly enrollment for the current and prior contract years.
- Current aggregate attachment factors, contract type (i.e., 12/12, 12/15, 15/12, PAID, etc.) and premium rate.
- Please indicate if aggregate coverage currently includes additional products other than medical only (i.e. dental, vision, prescription drugs), and include relevant plan documents and historical claims data.
- Requested quote options; contract types, and coverages (med/rx/etc).
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