PROPOSAL REQUEST
In order to get you the best quote possible there is some information we will need from you.
For Companies with 2 - 50 lives:
- Signed Small Group Employer Application
- Signed Small Group Employee Application - one for each employee, even if they are waiving
- Copy of Current Bill
- Copy of Current Plan Design
- Copy of Quarterly Wage and Tax Statement (MDES 1D) filed with the state
For Companies with 51 lives and above:
- Assessment Sheet completed and signed
- Employee Census including gender, date or birth or age, coverage type and zip codes for muti-site locations.
- Copy of Current Plan Design
- For self-funded plans, must include month by month enrollment and aggregate reporting. Three years is ideal, two years minimum.
- For fully-insured, rate information and any premium/claims reporting available for the last two years.