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Required
Quotation Information
- Firm
information – company name, industry type (SIC) and
headquarters location
- Census
(preferably in Excel) including date of birth, sex and dependent
status and employment status: active, disabled, retired or COBRA
participation. If there are HMO participants, the same information
is needed.
- Plan
document
or booklet and HMO schedule of benefits as well when applicable
- Multi-location
groups:
number of employees at each location with ZIP codes
- Large
Claim Information - click this link to
see the information we require
- The
employer’s contribution level
- PPO
network information
- Request
for Stop Loss Quotation
Please
email or fax quote submissions to:
BEST
Re
Quote Submissions
Phone: (877) 868-5775 ext. 254
Fax: (949) 222-1004
Email
BEST Re may be able to provide you with a quote if some information
is missing. However, the more information we receive the more
competitive our quote will be.
Employer
Groups Under 200 Employees
Employer
Groups Over 200 Employees
Employer
groups under 200 employees
Currently
Fully-Insured
- Carrier
history for the past three years
- Premium
rates currently in force and renewal rates; this is critical
if there is no claims experience available
- Plan
changes for the past three years, please list and give effective
dates
- Average
number of employee/single/dependent/family enrollment for the
past three years
- Claims
activity (if available) for the past three years
- Total
health premium paid by year for the last three complete years
Currently
Self-Insured
- Carrier
history for the past three years
- Current
excess loss rates, deductible levels, factors and contract basis
- Enrollment
and paid claims by month for the past three years. If there are
multiple benefits, please provide information broken down by benefit
type. Experience should be the most recent available and must
be no “older” than three months from the proposed
effective date.
Employer
groups over 200 employees:
Currently
Fully-Insured
- Carrier
history for the past three years
- Premium
rates for the past three years
- Total
health premium paid by year for the past three years
- Plan
changes for the past three years, please list and give effective
dates
- Enrollment
and paid claims by month, if possible, for the past three years
and within three months of the proposed effective date.
- Highlight
the “Extension of Benefits” provision in the plan
document which details coverage provided after the master contract
terminates for the totally disabled
Currently
Self-Insured
- Stop
loss carrier history for the past three years including TPA history
- Current
TPA, specific deductible, rates, factor(s) and stop loss contract
insuring basis and renewal information if available
- Claims
and enrollment data by month for the most current three years.
If there are multiple benefits, please provide this information
broken down by benefit type.
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