Documentation Required for A Group Quote
We are strongly committed to delivering quality health care designed for your company’s healthcare needs. By supplying the following we can begin your request for a self-funded quote. If you are in need of a fully insured quote please contact us for details on information needed to receive a quote. Please contact us with any questions.
1. Business name, address (all locations)
2. Contact name and phone number
3. Current census including the following information (for each employee)
· Age or date of birth
· Gender
· Single or Family designation
4. Total number of employees with coverage
5. Effective date
6. Insurance carrier for previous 2 years
7. Current plan type (Fully Insured, Self-funded)
8. Current benefits (please send Current Benefit Certificate)
9. For a self-funded quote it is also recommended that the following be sent:
· Current aggregate coverage
· Three years claim history
· Any large claims over $10,000
10. Any benefit changes desired
11. Requested completion date
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