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
Carolyn Shepherd
Phone: 877.868.5775
Direct Line: 714.299.0862
Fax: 949.222.2167
cshepherd@bestre.net

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

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.