Large Employer Group Enrollment

Information required for large employer group quotes

Please have the following information ready before completing a quote for a large employer group:

1. Client name and address
2. Effective date
3. SIC code
4. Total number of benefit eligible employees
5. Following details for all eligible employees (including waived members)
   • Full name
   • Gender
   • Date of birth
   • Level of coverage desired (employee, employee plus child(ren), employee plus spouse or family)
   • If eligible but waiving coverage, include the reason they are waiving
6. Employer contribution
7. HSA contribution (if applicable)
8. Copy of current billing, with or without rates
9. Completed medical loss ratio form (if applicable)
10. Claims experience:
    • Minimum 1 year, 3 years preferred
    • Diagnosis and status of all claims in excess of $10,000
    • Average monthly enrollment
    • Summary of plan design (SPD/SBCs)
    • Current carrier renewal analysis
    • If no claims can be provided, complete Health Conditions Statement
11. Rate tier levels requested (standard is 3-tier)
12. Commission amount requested (e.g., PMPM, PCPM)
13. Stop loss funding levels (self-funded only)