REQUEST FOR QUOTE OR PLAN REVIEW
Below is the list of information required in order for us to perform a plan review or secure a stop loss, pharmacy or administrative proposal.
Current and Renewal
*Current and prior if renewal not available or requesting mid-year review. If the group is currently self-funded, be sure to include rates, factors and admin fee breakdown
In excel, preferably
*Please be sure to include Employee DOB, Gender, Zip, Coverage Tier, and Plan Election. If available, please provide covered dependent DOB, Gender and Zip.
*Please provide current plan documents, if available as well.
Summary of Benefits for all current plans
Experience/ Utilization Data
*Please provide at least 18 months of aggregate claims data and large claims/high claimant data. If this is not available, individual health questionnaires may be required.
Details on what you are requesting
*Please either upload an RFP form showing what you are requesting or email your request to firstname.lastname@example.org. All data containing PHI must be uploaded below or sent securely.
Submit a Case
Secure Upload via Sharefile
Below is a secure upload section where you can upload the required information to request a plan review or quote. This is HIPAA compliant and secure. Please reach out to use if you have any questions. Someone will be in touch once we've received your data and provide an update once we have reviewed. Thanks!