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Embed code for: Information Needed for a Quote
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Information Needed for a Quote – RockHead
Group Name, and Industry, City State Zip of primary location and for each location (if multiple locations)
Current and Proposed PPO
Current Plan Design or the Coverage SPD from Current Carrier (and benefit changes if any during the past 3 years)
Proposed Benefit changes (if any) – not required during the quoting process but will help narrow down options
Current Census in Excel format
Gender, Date of Birth, Zip Codes, Status (active, retiree, union member, COBRA, etc.)
Dependents should be listed under each employee with the same information.
3 years claims and enrollment
Paid Claims and Enrollment by Month for at least 12 months (if unable to provide claims experience, employees will need to complete applications through FormFire)
Current Rates and Rates from last two renewals
Individual Large Claims information for past 3 years (50% of the lowest deductible being quoted)
Large Claim Information from Carrier (any claims over $10,000)
Carrier and/or TPA for each of the past 3 years